The relationship between patients and their physicians seem superficially very clear. The patient hires the physician to manage his/her health for a fee. In actuality, this relationship is much more complex. Physicians want to be respected and helpful and patients want to be cared about as well as cared for. When these needs are unmet, communication fails to the dissatisfaction of both parties.
Common complaints of patients about their doctors are: superior delivery by excessive use of incomprehensible medical terminology, poor bedside manner, haste and unavailability. Physicians discontent with patients often include: poor presentation of history of condition, non-compliance and excessive dependency (often characterized by suspicion and rebellion).
Debra Roter and Judith Hall in their book: “Doctors Talking with patients/Patients talking with Doctors: Improving Communication in Medical Visits” say “Patients need to feel that their doctor takes a personal interest in them as individuals, likes them, is concerned and committed to their welfare, and will consequently take pains to do a good job. The fulfillment of the basic need to feel known and understood begins with the telling of the patient’s story. “ Yet, Research by Beckman and Frankel found that “In 69% of the visits, the physician interrupted the patient’s opening statement after an average of only fifteen seconds to follow up on a stated problem…For those 30% of patients who were allowed to continue, none of their statements took more than two and a half minutes.” This early encounter certainly contributes to stress for the patient, who may be fearful and anxious to begin with and may feel discounted as well.
Physicians’ caseload causes pressure for efficiency and brevity, which may give the impression that they are impatient, disrespectful or callous to the patient’s needs. Doctors are also irritated with some circuitous presentation that hinders their clarity about the presenting problem so they can provide an effective and quick relief for the patient. They wish to explain, show their expertise and often do use terminology that causes patients some pause.
On future visits, some patients, due to lack of clarity, fears or mistrust have not fully complied with the physician’s recommendations, which further exacerbates the doctor-patient communication and relationship. The physician may see the patient as non-compliant and difficult and may seem displeased, affirming the patient’s fears that the physician is non-caring and unavailable.
These unfortunate communication barriers can be easily lifted if both patients and physicians adopted a different attitude. Understanding each other’s basic needs and emotions and addressing them clearly in their communication, can remediate these mutual misperceptions.
Here is what you could do to have a better communication and relationship with your physician and get the best medical and emotional care possible.
• Trust that your physician is interested in providing the best care for you. This addresses his/her need for being helpful and competent.
• Accept that though our doctor is busy – he/she does have the time to be exclusively attentive to you during your appointment.
• Make your initial presentation brief and clear: Reason for visit, length of symptoms, new or recurring, what makes it worse or better. Example: “I came for your help because of an ongoing headache I have had for a week. Have not had this before. Tried Advil, Tylenol and Aleve, none of which have helped much.” STOP. Wait for the physician to inquire further.
• Avoid circumstantial stories such as: “ I was visiting my mother in Fresno and we were in a store walking around and talking and then I got this headache.”
• Add your concern: “I am worried about a brain tumor.”
• Listen and repeat the recommendations and be appreciative.
• Once diagnosed, become as informed about your condition as possible.
• Bring a spouse or friend to future appointment to take notes. It is helpful in recalling and being a co-manager of your care.