Friday, September 20, 2013

More about Doctor-Patient Communication

Earlier this week, I finished the slides for a new presentation called "Successful Patient Tips."  My focus in this presentation is on trust and communication.  I believe that the people who are the most successful patients, i.e. they take excellent care of themselves, are the people who approach their doctors as they would any other human being.  Because these particular people carry the title "Medical Doctor," and have been through years of specialized training, it's easy to automatically trust them and assume that they're competent, or even fear them a little.  But "trust, then verify" applies here perfectly.  Trust them as doctors but also make them earn your complete trust.  You hire them, after all, not the other way around, and it's in their best interests to be trustworthy.

Communication is an essential element in building trust between two people.  As I worked on this presentation, I was thinking about the relationship I have with my GI doctor.  He tells me that he doesn't worry about me because he knows that I'll communicate with him if there's a problem.  He trusts me to do that.  I earned that trust by doing it over the time that I've been going to him.  Because we have that trust on both sides, it's gotten easier and easier to communicate efficiently.  There are certain things I say for a specific reason and never lightly or flippantly.  One is: "There's something very wrong here."  My GI doc knows that when I say that there really is something wrong.  I probably don't know what it is, but it's serious enough for me to use that sentence.  The last time I used it, at the end of May this year, it turned out that my Crohn's Disease had worsened and was flaring big time.  As a result of our efficient communication, we worked together to establish quickly what was wrong through blood tests and imaging procedures, and then worked together to figure out the treatment.

If your doctor uses a lot of medical jargon and doesn't respond well to requests for layman's language, that's a sign, to me, that he's more concerned about showing off what he knows than healing or communicating effectively with his patients.  It's important for you as the patient to stop this kind of behavior in its tracks.  Insist on jargon-free communication, and if he refuses or returns to his jargon, it's time to find a different doctor, one who is as concerned about clear, effective communication as you are.  After all, what's at stake here?  Your health. 

One issue that I've had to deal with regarding communication was a fear about bothering the doctor with stupid questions.  My mother, who revered doctors, brought me up to regard medical doctors as standing one bleacher level down from God and I shouldn't bother them unless I had a good reason.  It took me a long time to realize how wrong she was in this belief.  Doctors are human beings.  They possess deep knowledge about medicine, but they are only as good as their patient's ability to communicate with them.  They can have all the medical knowledge there is, but if their patient doesn't tell them all the symptoms he's having or isn't honest about the medications he's taking (or illegal drugs he's taking recreationally), the doctor won't be able to be effective.  I've often wondered how many treatment mistakes originate with the patient's lack of communication compared with a doctor's expertise or lack thereof.

When I first began having gastrointestinal symptoms, my upbringing prevented me from being straightforward in describing the symptoms.  I nearly fell off my chair the first time my primary doctor used the word "fart."  This was my problem, not hers.  It would take time, but eventually I became accustomed to the vernacular for GI symptoms.  I still prefer restraint in public, but in my doctors' offices, I tell it like it is using whatever language is relevant.  It no longer embarrasses me.  Now, I tend to feel anger about the way I was brought up, and the way it has hampered me at times in my communication.

Communication is a two-way street.  Everything a patient expects from his doctor, the doctor expects from his patient.  The doctor may think, "Can I trust this guy to tell me about all his symptoms?  Or take the medication as prescribed for as long as I tell him?"  The patient may think, "Can I trust this doctor to be able to treat me effectively?  Can I trust him to tell me the truth?"  The doctor-patient relationship is a human relationship, not one between god and worshipper.  And yes, doctors do care about their patients..... 

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