FInding the Right Doctor
Continued from "Finding the Right Doctor"
“There are several studies that show if the patient feels they have a good relationship with the doctor, blood pressure management is easier; frequency – and thus cost – of visits is reduced; pain control is more successful; and the number and cost of medications to keep the patient’s condition under control is reduced,” says Dr. Watts.
“In general, a good doctor-patient relationship is one where there is mutual respect and understanding,” says Dr. Watts. “Certainly in emergencies – a stabbing or a stroke, for example – the doctor has to behave as an authority to save lives. But most of the time, we don’t have the pressure of immediate decision making.” Instead, he says, the doctor must work in partnership with the patient, and vice versa.
“This goes contrary to the teaching of most medical students,” says Dr. Watts, “but a good doctor-patient relationship is very much like a good friendship.” That friendship, he says, allows the doctor to talk to the patient about lifestyle issues – such as quitting smoking or losing weight – from a position of caring, not solely as a doctor.
Mary Lou Bayer of Pittsburgh, Pa., knows this well. The 41-year-old has had osteoarthritis (OA) – and the same doctor to treat it – for 17 years. “He managed to get me to quit smoking after 23 years and has me halfway through a weight loss of 50 pounds.” Both changes, she says, have brought improvements to her OA as well as her general health.
Patients who feel at ease talking with their doctor, research shows, are more likely to comply with the doctor’s recommendations, and take prescribed medications, compared to patients who clam up in the examining room. Maura Daly Iversen, a physical therapist and an instructor of medicine at Brigham and Women’s Hospital in Boston, has observed this firsthand, teaching patient-provider communication. She has also witnessed it with her teenage daughter, Christina, who has juvenile rheumatoid arthritis.
Early in the course of her daughter’s disease, Iversen sought a doctor who was considered to be the top expert in the field. It didn’t take long to discover the best expert wasn’t necessarily the best fit. The next doctor they chose, however, was just what her daughter needed. “When I take her to the doctor now, she kicks me out of the examining room. Her doctor can elicit information about everything,” says Iversen. “Christina is very adherent to her treatment plan. I don’t even have to remind her to take her medicine any more.”
Following your doctor’s “orders,” such as remembering to take your medication or following a recommended treatment plan, can mean the difference between healthy joints and damaged ones, between remaining mobile and becoming disabled.
But what about a doctor who follows a patients’ orders or expectations? Both parties’ expectations play an integral role in this relationship’s dynamic.
Doctor-Patient Dynamics
Like any relationship, the doctor-patient dynamic is based on meeting needs – and expectations – on both sides. In the case of the cut requiring stitches, the need is simple and clear – and the expectation mutual – to have the cut stitched with as little pain and scarring as possible. The patient’s expectation is that the doctor is competent to provide safe and proper treatment. If he pulls it off, a patient will likely consider him a “good” doctor.
But when a patient sees a doctor for arthritis, needs may be numerous and expectations may range from basic to grandiose. You may expect your doctor to know how to minimize joint erosions, avoid joint surgery and improve mobility – all without risk of side effects. Or you may merely expect a prescription to help you through a flare.
And your needs and expectations may change depending on the urgency of the situation. For example, a patient who normally takes charge of her own health care may seek more guidance when faced with an unfamiliar and frightening complication. This patient may need her doctor to be a counselor on one visit or simply a confidante on another.
If your needs and expectations go unmet, you can leave disappointed, frustrated and feeling like your doctor is a dud. To avoid such situations, Iversen suggests taking time to evaluate your needs and expectations of your doctor. Then go to the doctor with a clear idea of your expectations, and make them clear to your doctor.
Ironically, the best antidote to having unmet needs yourself is to ensure you meet your doctor’s needs. While the doctor who sews your cut may need little more from you than to sit still and pay your bill, a doctor who treats arthritis needs extensive input from you, and that requires trust – a key component in the doctor-patient dynamic.
A trusting relationship with your doctor requires feedback and at times uncomfortable self-disclosure. Have you been exercising as recommended? Are you taking herbal remedies or trying other alternatives your doctor might not condone? Does a weakness for Cheetos or Twinkies make it difficult to stick to the diet he or she recommended? And most important, what are your treatment goals?
“Good communication is the most important part of the doctor-patient relationship,” says Dr. Buchholz. “Both parties need to be able to clearly communicate their goals.”
Should you go so far as to tell your doctor you enjoy moonlit strolls on the beach? Perhaps, if keeping your arthritic knees in shape so you can continue those strolls is a priority.
