This article is written by Martine Ehrenclou, M.A.. Martine is a patient advocate and award-winning author of "The Take-Charge Patient: How You Can Get the Best Medical Care." Learn more about Martine and her work at thetakechargepatient.com.
After two business trips that took me to Palo Alto, CA and Dallas, TX, with only a week at home in between, I knew that the cold I’d had for six weeks had somehow made its way into my ears. The plane flights had shoved pressure into tender ear canals and sinuses, causing pain and congestion in both.
After trying allergy medications and decongestants for six weeks, I knuckled under and saw a doctor. I hadn’t felt good for a while and it wasn’t just the ear and sinus pain but a deep down fatigue and intermittent low fever.
Seated in an exam room, noticing the smell only well-travelled doctor’s offices have, I greeted the doctor I’d known for years. Sometimes he was moody but mostly pleasant and affable. After discussing my symptoms, Dr. Y asked about my latest book, The Take-Charge Patient. We chatted about healthcare reform and its implications for physicians.
After an exam of my ears, nose and throat, Dr. Y said he didn’t see evidence of infection and launched into a regimen of allergy medications and seven days of steroids. He explained that inflammation and allergies were the cause of my symptoms.
“The fever too?” I explained that I’d not been feeling well for a while and had been taking allergy medications and decongestants with no success. I repeated my symptoms, adding in a few more for the sake of emphasis, because after all, I wouldn’t have been in his office if I hadn’t wanted a prescription for a-n-t-i-b-i-o-t-i-c-s, the dreaded request for many doctors.
Dr. Y grew curt and corrected me. “It’s not an infection. Maybe you picked up a virus on the plane.” He gave me detailed instructions about the steroids and allergy meds.
I explained that I was nervous about taking steroids since I’d been on them for a year and a half for a medical condition and I was concerned about reduced bone density and other possible side effects.
Raising his voice he said, “Steroids naturally occur in the body. There’s nothing harmful about them. You’re worrying needlessly.”
I twisted in my seat. I didn’t want a confrontation, just “shared decision making,” a mutually agreed upon treatment plan after a mutual discussion involving questions from both parties. That is what patient-centered care is all about, something I’d described in my book. I said quietly, “It feels like an infection.”
He leaned back on his stool in front of me, arms crossed, and scoffed. “So, you’re the doctor now?”
That irritated me. I slid into a not-so-diplomatic mode, something I rarely do with medical providers and said, “I bet I’ll be calling you in ten days with the same symptoms.” Okay, maybe I let that slip because I wasn’t feeling well, or maybe it was because I was not being respected as a patient.
Dr. Y laughed, and not a nice laugh either.
I thought maybe I’d crossed the line but I think he did too. He wasn’t listening to my valid concerns about taking steroids, even after I’d shared the rather alarming results from my DEXA scan and my primary care physician’s concern about loss of bone density after all the steroids I’d taken. Dr. Y might have had a valid objection to prescribing antibiotics, but he could have said what many doctors say: “Try the steroids for four days. Here’s a prescription for an antibiotic but don’t fill it unless you’re not better after the four days.” That’s giving the patient some control, some say-so when it comes to his/her body. That simple gesture implies that the doctor takes the patient seriously but is also asking the patient to take the medical advice into consideration.
I added details about my symptoms, mentioning a few specifics directly related to infections.
“Well,” Dr. Y said, “you didn’t tell me that.”
Okay, so I hadn’t, but it was my persistence with giving a detailed history that contributed to him further considering my opinion. I also wanted him to remember my experience with infections, in particular sinus infections, wanted to remind him that I was a credible patient. “The symptoms are similar to all those sinus infections I used to have, same feeling but with new ear pain.”
I guess I had convinced him or he simply backed down. Dr. Y wrote out a prescription for antibiotics and one for steroids. I took the antibiotics and a few days later I felt better than I had in six weeks. I never took the steroids.
This is an example of what you don’t want with your doctor. It shows what a poor relationship with a physician looks like, complete with unsuccessful communication and what results from that—lack of patient compliance with the proposed treatment plan. What constitutes a good relationship is a partnership, successful communication and mutual respect. Good relationships with physicians define the quality of care. According to the Ochsner Journal, a good relationship with a physician increases the quality of care, increases patient safety, decreases misunderstandings and can reduce cost.
Let’s get to the basics of what makes a successful relationship with your doctor.
> A Successful Patient-Doctor Relationship
> 1. You feel a personal connection with your doctor. Either that started when you both shared conversation about something you both have in common or it emerged based on a sense of kinship. You like your doctor and he/she likes you.
> 2. Good communication. This is an essential component to a successful relationship with your medical provider. You and your doctor listen to one another and you feel heard. You understand what your doctor says, and if you don’t, ask him/her to repeat or redefine instructions until you do. If you have mutual understanding, meaning you understand what your doctor is sharing with you about your medical issues and he/she understands you, then you are off to a good start.
> 3. You are comfortable asking questions. Now, this is a tough one for a lot of people because we’re afraid of offending our doctors, afraid they’ll see our quest for information as challenges to their expertise. Muster your courage because if you don’t ask those questions, you’ll be less likely to follow through with what the doctor advises and that undermines the relationship. An important part of creating a collaborative relationship with your doctor is the freedom to ask questions about your illness, disease and proposed treatment plan.
> 4. You are a participant in your care. To create a collaborative relationship, you as a patient need to be involved, engaged in your health and medical care and in the relationship with your doctor. Nothing affects interest on the part of a doctor more than a patient who just doesn’t care.
> 5. Mutual respect. This means that both you and your doctor respect one another as people, and respect what you both bring to the table. Your doctor brings medical expertise, and you bring your expertise with your symptoms, experience with your illness or condition and preferences about treatment plans.
> 6. Mutual honesty. Honesty with your doctor goes a long way. If you’re truthful, even about embarrassing habits or symptoms, or medications you stopped taking, you are seen as a credible patient. Credibility is what you want. This enhances trust. At the same time, if you don’t trust your doctor, walk away. A relationship based on lost or absent confidence in his/her capability as a medical professional is not worth your time.
> 7. Mutual discussion. The doctor’s office isn’t a classroom and you’re not the student. It’s perfectly acceptable for you to engage in a discussion with your doctor about important aspects of your medical care. Maybe you’re unsure about the diagnosis. You can ask in a polite manner, “Are there any other possible diagnoses for what I have?” You both probe for information—you probe for information about what the doctor is suggesting for you, and he/she probes for information about whether what he/she is proposing works for you.
> 8. Shared decision-making. A good relationship includes coming to a mutual agreement on a treatment plan, based on your doctor’s expert medical guidance, your preferences and values, tolerance to risk and more. For example, if you aren’t comfortable with surgery and there’s a good alternative, make that known. Doctors know all too well that if you don’t get behind a treatment plan he/she has suggested, you’re not going to follow through. Better to share your concerns up front.
A successful relationship with your doctor means a collaborative one, meaning you are part of the conversation. The journal, Therapeutics and Clinical Risk Management reports that partnerships and effective interpersonal communication make it possible for patients and physicians to work together to help patients follow mutually agreed upon recommendations.