Going For The Throat: Improving Patient Care, The Doctor’s Perspective, Part II: My Crude Analysis
Written by Robyn Davis Hahn
Last week, I shared some unedited responses from several physicians to 3 simple questions I had posed to them. Basically, it asked them to comment, from their perspective, on the biggest mistake patients make, the biggest mistake doctors make, and the biggest overall obstacle to improved patient care. You can read the article and detailed answers here. This week, I’m offering my take on their answers, and what this means for patients.
The doctors all had very different answers on the biggest mistake they perceive coming from their patients. Two commented on the internet being a double-edged sword of both information and misinformation, leading to possible preconceived ideas or mistrust. One stated that not discussing all symptoms, or not describing them accurately was an issue. Others included being closed minded (entering the discussion with prejudice), not asking for clarification about treatment plans and/or diagnoses, and lack of understanding of the time stresses on the doctors.
To me, this boils down to errors in education (information) and/or communication: either entering the exam already thinking you know what’s going on and how to treat it, or not accurately representing your symptoms or feelings and/or your understanding of your diagnosis and treatment plan. Certainly, commencing a relationship with a doctor and feeling that you know as much, or more, than they do about your disease is not going to be popular with them, even if it’s true. To be fair, almost anyone would be defensive if faced with someone who acted like they knew more about a subject to which you devoted a huge portion of your life and education!, I think this attitude can get us in trouble with ourselves as well–having a strong opinion in any direction is less likely to lead us down the appropriate path. Better to have thoughts or insights while keeping an open mind, then to pridefully think we have all the answers and view our doctors as a stumbling block or just a medication dispensary!, We can make our knowledge and information known, relevant, and non-threatening when we approach our doctor as a team mate.
“What are your thoughts on T3 therapy?, Is this relevant in my case?, What are the pros and cons of this approach?, Have you seen cases like mine that benefited from any additional or different treatments?, Should we be exploring other causes of my symptoms–could you tell me about adrenal fatigue? Contrast these questions with these: “Synthetic hormones aren’t working. I want Armour…, “I’ve done research online and just know I have adrenal fatigue. I want testing for this or cortisone… You may very well know more about a subject than a particular doctor–and you absolutely know your body better than anyone, but open ended questions will begin a dialogue, and you may both learn something by communicating this way. Your doctor may have not considered you a good candidate for T3 therapy because you are at high risk or have underlying heart disease, or some other scenario which you may have not considered.
Remarkably, all the doctors had the same opinion of the biggest mistake doctors make in patient care. Not having or taking the time to develop a relationship and listening to patients was described in some manner by EVERY doctor. For many of us, this is not breaking news. Some aspects we are not going to be able to change–none of us can expect bevies of personal phone calls for results or a doubling of allotted appointment times–but with this knowledge we can tip the balance in our favor.
How do we get our doctors to listen to us?, Really listen?, There are two primary components–open communication and actively listening ourselves. Make sure that when you speak to your doctor, you are specific (instead of “I’m tired all the time say “In the past month, I’ve slept 8 hours each night, and still need a 1-2 hour nap several days each week), concise (instead of “So, it seems like I feel cold a lot–I often need to wear a sweatshirt around the house. And I’m just really run down, I never seem to have any energy and I could fall asleep standing up if wasn’t careful. Oh, and I have to wear socks to bed, too… say “My primary continuing symptoms are cold intolerance, increased need for sleep), and direct (be clear and assertive, but kind, “My symptoms tell me my thyroid is still not optimally balanced. I would like to discuss additional testing/T3 therapy/etc…). Then, it’s our turn to actively listen–repeat what your doctor says back to him or her, so that you are both sure you understand (“You are concerned about initiating T3 therapy for me because I have been extra sensitive to medications in the past…). As stated above, open ended questions also promote a team approach–your doctor can talk with you, not at you, and you both can feel confident you are on the same page. Make sure you end each appointment knowing the short term plan (such as increasing medication dosages), the long term goal (such as lab values in an acceptable range AND feeling improved), when to expect any results, and when to schedule follow-up appointments. , Personally, I also ask at the end of each appointment if my current response to treatment is typical in my doctor’s experience (and if not, what he feels is the cause), how our plan will change if I am not responding as presumed, and if there are any other factors or problems we have not yet considered or discussed that could be part of my particular case. If all your best efforts fail, ask your doctor (really!) or friends for a recommendation for another physician.
Lastly, the doctor responses touched on two overall obstacles to improving patient lives. The influence of health insurance was one–lack of good coverage, insurance dictating allowable treatments, and placing the doctor and patient at odds with each other. My (admittedly superficial) research on insurance is that it is one tangled mess–like the tax code–and will be difficult to navigate globally to be of any help individually (although I will do my best in the future). The other major response was a lack of compliance–patients not following treatment plans, and resisting lifestyle changes such as improving diet and exercise to improve their general health. This is the part of our health that we have the greatest ability to control–it is our responsibility to do our part to maintain our body and give it the best chance to manage and heal.
To many of you, I may be starting to sound a bit repetitive. I think better communication is the essential ingredient to a better relationship with our doctors. By improving our side of the communication, and learning how and why most doctors communicate the way they do, we can ultimately guide our health management in a positive direction. At the very least, we can begin to recognize our (doctors and patients) communication weaknesses–we can only fix what we know is broken!
Conversation happening in the forums about this topic! Speak up and out. Share your thoughts. What do you think will improve patient/doctor relations? What isn’t your doctor doing that s/he should be? Spill everything right here.
Tags: conveying symptoms, endocrinologist issues, Going for the Throat, Health Care Column, improving patient doctor relationships, patient responsibility, Robyn Davis Hahn Health Care Writer, speaking with doctors, thyroid health, thyroid patient issues