Doctor and Patient
Building a Better Relationship
By Dr. J. Blake Long
A generation ago, patients expected their doctor to tell them what to do about their health and doctors expected their patients to follow orders. Simple as that.
If a doctor said, “You need a mastectomy,” or “I need to put you on insulin,” chances are the patient complied. Today, the relationship between doctors and their patients is more complicated.
Patients search the Web for the latest medical news. They watch television talk shows. They read studies and magazines and come to their appointment ready to challenge a doctor’s orders.
Doctors’ expectations have changed, too. Doctors in my generation are trained to offer options for care. I see myself as a consultant, as someone who can guide my patients to better health. In my internal medicine practice at Wake Forest Baptist Medical Center, I try to understand a patient’s life, values and attitudes and use that to shape the treatments I recommend. In the long run, I believe this model works better than the old paternalistic style of medicine, but only when doctors and patients build a solid relationship based on trust.
Health Care Agenda
Your primary care physician has an agenda for your appointment. It includes a list of questions about your medical history and your lifestyle. The nurse will weigh you and take your vital signs and your doctor will order a battery of blood tests to help diagnose any underlying disease.
So what’s your agenda? Before you see your doctor, think about the issues important to you.
Are you worried about your weight? Do you have trouble sleeping? Are you anxious about your job? What about that pain in your back? That bloated feeling you can’t quite describe? Don’t be afraid to bring a list of questions with you when you see your doctor but understand that your doctor may not get to every question in one appointment.
Know Your Medical History
Your health is shaped by many factors, with lifestyle and a little luck all playing a role. Genetics shapes us too. Which means it’s important for you to know your family’s medical history. Did any of your grandparents have cancer? Is your mother an alcoholic? Did your father have a heart attack? Do any of your brothers or sisters suffer from diabetes? A family history of illness doesn’t mean you will automatically suffer the same illness, but your doctor needs to know that history.
What about your own medical history? I’ve treated patients who know they had cancer as a child but they don’t remember any of the details. I need to know what kind of cancer and how it was treated so that I can watch for a recurrence and any effects from treatment.
What about your recent medical history? Remember those abdominal pains you suffered five years ago? You went to the emergency room and but now you don’t remember what the doctor said. It would be helpful for me to know.
Honesty Works Both Ways
Like any good relationship, the relationship between a patient and their primary care doctor is based on honesty.
I learn some of what I need to know about a patient through a physical exam, blood work and other tests. But I have to rely on my patients to tell me the truth about their lifestyle. It’s up to my patients to tell me with accuracy whether they smoke or drink and their sexual history. And only my patients can tell me about their exercise routine and whether they sneak downstairs after everyone has gone to sleep to polish off that bag of chips.
I know my patients tell me half-truths. So, what do they not tell me about? Almost everything. What they’re eating. What they’re drinking and how much. And whether they take their medicine. But I would rather work with a patient who won’t take the medicine I prescribe, but at least tells me, than treat someone who tells me half-truths.
Patients should expect honesty from their doctor, too. Your primary care physician should be honest with you about your prognosis, the risks and benefits of treatment and the chance of a cure.
Patients should also be able to count on a doctor to deliver bad news. Your doctor should be able to tell you it’s time to quit smoking, or that you’ve become too fragile to live alone or, tougher still, that it’s time to consider end-of-life care.
Understanding Your Values
Most of us come to the doctor’s office with a set of values and ideas about health and medicine.
Many patients have preconceived notions about illness. They might believe that depression is a sign of weakness and won’t admit to feelings of despair. Many diagnoses – from diabetes to epilepsy – carry a stigma. I need to know what you believe about these illnesses so that I can help you manage them.
Many patients today believe in alternative treatments. They see a chiropractor for back pain and they rely on herbal remedies when they feel depressed. Your doctor needs to understand these choices.
I know it’s hard to be honest about these complex subjects, but honesty makes me a better doctor and you a better patient.
Dr. J. Blake Long is an instructor in the Department of Internal Medicine at Wake Forest Baptist Medical Center.
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