A request to my doctor: Listen, answer, explain

By Ralph Warren

After a recent less-than-satisfactory appointment with my cardiologist, I was troubled by how common poor relationships between doctors and patients are. When did doctor and patient relationships, so necessary to the successful treatment of long-term illnesses, become adversarial?

After rearranging an appointment twice to accommodate my cardiologist’s schedule, I was disappointed that he had not allocated adequate time to discuss my medical issues. He did listen as I detailed my symptoms, but I am not sure he heard me. My complaints were brushed aside as if not worthy of attention, and I was rushed out the door without solutions. It was clear my cardiologist was in a hurry to see his next patient. I departed feeling as though I was an imposition rather than a partner in my medical treatment.

I recognize that there are deficiencies on both ends of the stethoscope. It is not the medical profession that bears the full blame for the disruption between us. I share some responsibility for the breakdown. I should have voiced my concern and confusion immediately before leaving the office. That is a shortcoming I must work on improving.

In years’ past, patients did not actively participate in their treatment. However, in today’s world, “respect, but question” is a beneficial and often expected model of care.

No one would accept a medical professional ignoring critical warning signs without a cursory inspection, nor arbitrarily dismissing symptoms. Imagine my confusion when the very symptoms my doctor ignored were those on his watch list as danger signals? Imagine that.

I am your patient, and the very reason for your profession’s existence is care and treatment of me and other patients. Without us, what would the point be?

Some doctors rightly complain that patients use the Internet as a diagnostic and treatment tool. However, has it ever occurred to these critics that is so because patients can’t get answers? Many doctors just don’t have the time and won’t take time for patients. I would much rather prefer to rely on your training and expertise than the vagaries of online resources.

Most doctors are exemplary caregivers, and yet, very few physicians comprehensively use the skills they have spent so much time to perfect. Does anyone really believe a 5-minute office visit for a patient with significant health issues adequately achieves a proper diagnosis and treatment? Assembly-line practices only work when the individual parts and procedures are identical. Unfortunately, no two humans are alike.

Patients understand that there is a shortage of medical professionals, but shortchanging us all to compensate doesn’t solve the problem.  Quality of service is what we are looking for, not necessarily time. Listen, answer, and explain. Those three words sum up what we would all like to receive. When a patient identifies a symptom, take the time to explain why, in spite of it being a red flag, you feel that it is nothing to worry about.

The study and practice of medicine is your passion, not mine. My interests lie elsewhere, so I would prefer to relinquish my care to your expertise rather than chase all the anecdotal leads on the Internet. Let’s work together as a team to resolve my medical issues and develop a collaborative, long-term relationship. Let’s open a dialog to understand how we both can best achieve this goal and get back on track.

I’m glad I got that off my chest. As a heart patient, I’ve already got far too much to deal with in that region.

Ralph Warren lives in Tucson AZ with his wife and herd of assorted animals. Since a significant cardiac episode forced him into retirement in 2007, he divides his time between volunteer work with cardiac patients, and creative endeavors.

 

Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.

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  • Marie

    Recently had this experience with my loved ones ONCOLOGIST, did complain and now I am the quote ” Bad Guy”. I am just trying to look out for my loved, the head of the centers excuse is he the oncologist is from Syria and he isn’t receptive to women having an opinion. That is so much bull, he sure met the wrong person, then. Why is it that no one seems to pay attention when you see a doctor isn’t paying close enough attention to a patient and their symptoms?

  • Joan Jahnke ( joanincarolina)

    I really loved reading this article. I am a retired RN and have worked in the clinical areas of hospitals, clinics, and outside clinical practice with healthcare management companies. I see and get all sides of the doctor, patient and payor system.

    What touched me was the comment about using the internet for health information. This is the age of a open flood gate of valuable information and many doctors and potential patients use this tool. If I had not gone ‘googling’ in 2005 and found legitimate information at the National Institutes of Health (NIH), not found pertinent cardiac studies done by research facilities, then I would either be dead or severely more disabled then I am with a little known ailment called Cardiac Endothelium Dysfunction. You bet I brought every piece of new found data to my doctors and the process to some treatment began with my referral to Emory.

    It is my health on the line and each visit to my physicians was well prepared with data, questions and concerns. This dysfunction is an example of a disease process under NIH review for 30 years and there was little written for my physicians to learn about it. I, and they, didn’t mind that I did the time collecting information that benefited all concerned.

    Good column Mr. Warren.

    • Ralph Warren

      Joan ~
      I appreciate your response.

      Your story, is both inspiring and troubling. Inspiring that you were able to use internet resources to help identify and treat a serious medical problem, that doctors could not identify. Troubling in that far too many patients follow the same path, and explore the information available on the net then clog the medical system unnecessarily demanding tests and treatment for ailments they may not suffer. As a nurse, you are bound to be more objective when exploring medical information. Most patients are looking for that miracle diagnosis and cure whether necessary or not.

      I use the net to understand my ailments, and medical treatment and terminology only so that I may ask intelligent questions, understand, and follow my doctor’s treatment.

  • http://twitter.com/MHoskins2179 Mike Hoskins

    Ralph, thank you so much for writing this. I very much enjoyed reading it. You’re so very right that many docs don’t listen to patients and often look down on those who use the Internet. It’s almost counter-intuitive – if they have so little time, why wouldn’t they welcome more e-patients who can come in with specific questions and issues to address rather than trying to cram everything into 7 minutes? I’ve tried to encourage my endocrinologist to put more stock in my involvement with the Diabetes Online Community, which provides that needed peer support that no medical professional has been able to provide. That helps motivate me and keep me accountable in my D-Management, and I just want my Endo to recognize the value in that. But she hasn’t, to date… a shortcoming I’m trying to address. But like you, I’m also working on my own improvements like letting her in, and communicating more. It’s a work in progress on both sides, I think. Here’s to a future where more docs listen to us!

    • Ralph Warren

      Mike, thanks, glad you enjoyed my article.

      On the flip side, far too many patients are in fact using dubious internet sites as well as self diagnosing and wasting too many medical resources by unwarranted appointments and tests to prove their self-diagnosis was wrong. Too many patients believe the anecdotal stories they hear.

      I use the internet to understand my affliction, the medical terminology, and treatments for same so that I may understand my doctor better. But, I came to recognize early on that it can be a source of stress and lead you down the wrong path.

  • PAprovider

    Ralph,
    I can understand your point of view. I currently work in health care as a physician assistant. I agree that when someone asks a question, they should get a complete answer. The issue at hand is the fact that the provider has an agenda and the patient has an agenda, but they don’t always match. The provider is looking at what needs to be addressed in re: to the medical history (for example: hypertension, lipid levels, blood glucose, etc.. to make sure those are all complete and that if the patient is on Rx, that they are working or if something needs to be changed. This is all while maintaing that the patient is at goal per guidelines). Now, the patient wants to know why _____? So.. there is the problem at hand. The doctor is trying to make sure that the patient is getting to goal re: whatever the medical history is.. and then trying to add on any new information that the patient is concerned about.

    Re: using other resources for information.. Shame on any provider looking down on a patient who takes an active role in their healthcare. Now.. there is a limit on what is a good resource. Just saying “I found this online and I think I have xxxx” is demanding test xxx: that is not acceptable. But, if a patient brings in information re: a disease and asks if I have thought about it and would like to know about xxx. I am all for communication between provider and patient.. but there are sometimes the provider needs to make the decision if that is important enough to discuss, even though the patient may think it is, the provider may not.

    sorry to ramble.. just my two cents.

    Overall don’t forget that “the squeaky wheel gets fixed”

    • Ralph Warren

      Thanks for your input.

      The doctor and patient objectives should not be divergent, there is no way to be successful if you are working toward different goals. It is important when selecting a doctor, that we have an open discussion about goals and objectives with each other to assure we are in sync with the treatment.

  • http://www.mightycasey.com/ MightyCasey

    It’s a doctor’s job to listen. It’s a patient’s job to listen. They gotta do this in series, and in parallel, for the healthcare circuit to be fully powered. Sorry, a long time spent working with electronic gear leaves its mark.

    If you’re lucky enough to live in an area with more than one doc, find one that believes in, and lives, teamwork. Doctors who don’t welcome the idea of treating patients as sentient, able collaborators should be hounded from the profession.

    No, I’m not kidding.

    • Signify

      I’ve been an advocate for others, as well as myself, for over 40 years. Bringing lists, taking responsibility, taking more responsibility — all that – was, and is solely a means to avoid having to hit the streets in active, ongoing protest. Then again, the fear is – what will we do if we have an emergency, and, are we able to simply face whatever end time we may be up against.

  • http://www.thehappymd.com/ Dike Drummond MD

    Hey Ben — thanks for the post and there is so much about your unsatisfactory visit that is avoidable and not entirely the responsibility of the physician.

    Your doctor was over stressed and most likely symptomatically burned out on that day. The first thing out the window when you burn a doctor or nurse out is their ability to be present, empathize and listen to you. It is commonly known as compassion fatigue. It is a symptom of burnout NOT a normal aspect of being a doctor. Being a bad listener is a symptom … not a basic character trait of physicians.

    AND your doctor is almost certainly an employee inside a large healthcare organization and has no responsibility for creating the patient flow and scheduling system that controls every moment of his work day. Nope … that is put together by people with no experience of taking care of a sick, hurting or concerned patient. Administration knows about spreadsheets, production quotas and keeping the schedules moving though.

    Your visit is a microcosm of why there is such and URGE TO OCCUPY HEALTHCARE. And I encourage you to see it as a TWO LEVEL OCCUPATION.

    It is to set up systems that work for BOTH the health of the patients AND THE DOCTORS AND STAFF IN THE SYSTEM. You can’t build patient centered care on the backs of burned out doctors and nurses. AND happy doctors naturally have happier patients. The top performing companies in every industry outside of healthcare understand you must take excellent care of your people. Healthcare doesn’t get it for reasons I detail in this article

    http://www.thehappymd.com/are-physicians-the-canary-in-the-coal-mine-of-medicine/

    BOTH the doctors and the organizations bear responsibility for creating systems that are not toxic to the workers. So often patient satisfaction is driven by simply cracking a whip over a system full of burned out doctors and nurses. Just like happened here.

    Don’t shoot the doctor … help create a system where this kind of interaction is highly unlikely to happen … rather than a disappointing experience of meeting our abysmally low expectations. :-(

    My two cents,

    Dike
    Dike Drummond MD
    Over 117 ways to prevent burnout in the MATRIX
    http://www.tinyurl.com/bpmatrix

    • http://twitter.com/miller7 Ben Miller

      Thanks for your comment, Dike. You make several great points – I just want to point out that this is Ralph’s post not mine. That being said, you are spot on with us all working together to create the system that we want not the system that we have!

    • Ralph Warren

      Dr Drummond ~

      Thanks for taking time away from your busy schedule to respond, your perspective is much appreciated. Rest assured, I have no intent to “shoot the doctor.” In fact I hold him in the highest regard. Pointing fingers in any direction is non-productive and not my goal. But, your response is a step forward in improving communications. If we can keep a dialog going between the patient and medical communities, I believe we can successfully begin to chip away at the barriers building up between us.

  • Deb Discenza

    Very insightful column, Ben. And I hear you.

    As a parent of a child born prematurely and who has residual developmental issues I have found it takes a two-prong approach to working with my child’s professionals medical and therapeutic.

    First off, I find that my having things written down (questions, data, reminders for prescriptions to be written, etc.) makes a huge difference because as the doctor/therapist is busy, so am I. We both respect each other’s time when I take a moment to properly prepare for the meeting. He/She comes to the meeting prepared through training and such and when that won’t suffice, tests must be done, etc. But my preparing allows us to focus on a meaningful conversation rather than sift through a minutia of detail.

    Second off, I also tell the doctor/therapist what has helped my daughter in the past from his/her treatments/guidance. Taking a millisecond of my time to do this can really help that doctor not only help our family but also stave off the compassion fatigue that Dr. Drummond noted. Our professionals are human just as we are and we need to give them a pat on the back when possible. I am not saying they shouldn’t be held accountable, but when things do go right then we should say so with enthusiasm. How would you like it if you spent your day hearing complaints? To me this is the essence of a true professional/patient partnership.

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  • Ralph Warren

    Thank you all for the responses, your perspective and
    suggestions are highly valued. I do want to clarify that the intent of my
    article was not to indict the medical profession for the poor doctor patient relationship,
    I have the highest respect for my entire medical team. The intent to was capture
    their attention so we may enter into a meaningful dialog. A discussion that,
    can perhaps, lead to a more effective relationship between the medical
    community and their patients.

    • Signify

      I see absolutely no reason for you to rise to their defense, but I suppose you must, otherwise, like so many of us, you are left with total self-care until you, (we), hit the ER, and even then…

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