May 18, 2010

Doctor - Patient Relationships

As important as good doctor – patient relationships are, they do not exist with regular frequency. What prevents these relationships from forming, or at least developing into a tolerable relationship? I am not sure I have all the reasons nor will I claim to be an expert. Even though these types can fit many diseases, diabetes is the disease of choice for this analysis.

There can be more classes of patients and doctors, but further breakdowns may fragment the discussion.

Reasons patients do not fit with doctors:

Types of patients:

One. These patients want a cure, but only a natural cure; and will not cooperate by taking the medications prescribed by the doctor. These patients head for the nearest health food store or place where they can obtain something that will naturally give them the cure they want. It does not matter that there is no supporting scientific evidence to say that it may or may not give the benefits desired, as long as the clerk promotes it, it was advertised in a magazine or on TV, a neighbor claims it worked for them, etc., they have to have it. For these people with diabetes, unless they are able to control with nutrition and exercise, it is going to be a difficult case.

Two. These patients are not listening to the doctor and very seldom ask questions. These patients cause the good doctors worry as there is something wrong and all they are looking for is a quick fix and get out the door. These patients think that a doctor is like an auto mechanic. A little bottle of medicine here, and a shot there, and they will be as good as new.

Three. These patients can be a challenge for any doctor. Always contradicts the doctor and disagrees with what the doctor is saying. These patients can be a combination to some extent of one, two and four.

Four. These patients have a symptom for everything they hear about and will not let the doctor go until they have explained the symptom (most of the time may be non-existent) and tried to convince the doctor to investigate by doing this or that test. These patients can easily be classed as hypochondriacs. They are the dread of every doctor.

Five. These are the compliant patients by the medical communities definition. They blindly follow the directions of the doctor and do everything lock-step that they are told. They ask the questions that the doctors expect, are not proactive in their care, and never question the doctors advice.

Six. These patients are proactive in their care and understand patient empowerment. They may not have all the answers or questions at the first meeting, but once they have a diagnosis, they are off to the computer, the library, the pharmacist, or other resources to get an education and learn whatever they can to manage whatever is wrong with them. They will generally react favorably to what a good doctor tells them and they want to get control of the disease with the doctor’s assistance.

Reasons doctors do not fit with patients:

Types of doctors:

One. These doctors generally do not care about their patients, only the tee-off time and how they are going to win this afternoon. If it is not golf, they may follow some other sports activity. They are more concerned in getting to their seat on time, what the betting spread is, and whether they have a chance to win on the game. Or, they are looking for other ways to earn more money with only a small tax impact. These doctors are not putting their patients first.

Two. These doctors talk at the patient and let their blind spots rule in the patient – doctor relationship. They show some concern for their patients, but only if the patient fits their perception of being compliant and follows them lock- step.

Three. These doctors feel they are the only doctor that the patient needs and are very antagonistic toward any patient that is proactive in their health care. These doctors are not in favor of patient empowerment and will find ways to belittle their patients.

Four. These doctors are so impressed with the qualifications and letters they have behind their names, that they seldom listen to their patients. They also can belittle their patients and often leave their patients wondering what has been said. They know their specialty, but not how to communicate to the patient in a way that the patient understands or can even decipher what is happening, what to do, or even when to alert the doctor if a medication is causing problems.

Five. These doctors are close to number six; however, they still lack some confidence to talk with patients and can work well with a group of specialists whom they trust and work with. They are good doctors technically, but are lacking in some of the interpersonal skills that make good doctors great doctors.

Six. These doctors are self-confident of themselves and their surroundings. They are ready to take on the world one patient at a time. They know when it appropriate to joke, when to be serious, how to deal with each patient, and when to listen intently to a patient. Then they know how to talk with the patient, drawing the patient out and including them in the treatment. They know how to assess the patient’s mood and what the patient can do and what they will be capable of accomplishing. These doctors know how to surround the patient with caring specialists and have people available to answer questions and give excellent guidance when and where needed.

Getting patient type six and doctor type six together is a challenge for either side . The patients often can not find these doctors as many of them are already booked full because they are who they are.

Unfortunately, this world is not full of type six patients and type six doctors.

For another view of the doctor-patient relationship read this by Amy Tenderich and the two tips and their links, and what a doctor says – read both the articles from 11/3/09 and 11/10/09.