Chart Your Healthy Doctor-Patient Relationship
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Chart Your Healthy Doctor-Patient Relationship

Five Tips to Become an Empowered Patient

How many of you have ever been either sick of your doctors or sick of the system? It hurts, doesn’t it? The reality is doctors are scientists. We as patients just want to feel better and be fixed. Doctors may be trained in bedside manner, but it’s not completely up to healthcare professionals to keep us well.

We as patients have to learn to meet in the middle to create relationships with our healthcare providers for life-long healthy living. After researching my new book Sick of Doctors a Prescription for Patient Empowerment for five years, here are a few tips I’ve found to be effective when creating my personal health care team. I hope they work for you, too.

1. Shop for Your Doc

Have you had good doctors?

Bad doctors?

Indifferent doctors?

Well, I’ve had all of them. The good ones are truly treasures. Depending on the ailment, I’ve discovered adjusting my bedside manner in partnering with a doctor always helps the outcome.

One of my favorite doctors was the orthopedic surgeon who was matter of fact—like me. He told me that there were only three things he could do to help my rotary cuff problem in my shoulder. He could provide medication (steroid injection), information, or surgery. I loved his frankness. He was neither arrogant nor curt, but simply gave me the facts.

Some of my bad doctors were really bad – like an incorrect diagnosis. Instead of saying, “I don’t know,” the doctor decided to give me my problem a name – multiple sclerosis. Another one, an oral surgeon, insisted on multiple surgeries. I finally complained to the internist who had recommended him and an investigation was launched. He had a serious substance abuse problem and needed the surgery-procedure money to buy his drugs.

The indifferent one was an internist – a new doctor to me. He appeared to be very bored, suggested that his assistant would give me instruction about some tests and I never heard from either of them again.

Then there is the most dreaded one – Dr. God. Have you heard the joke “What’s the different between God and a doctor? God knows he isn’t a doctor!” How many of you know a Dr. God? Would this be a description? –Arrogant, bossy, know-it-all, impatient – well, you get the idea. In my latest book, Sick of Doctors? A Prescription for Patient Empowerment, I describe situations that reveal the impact doctors with this type of personality have on everyone around them – co-workers, nurses, wives, peers.

Regardless, the truth is we have choices. We’re the doctor’s customer. It’s up to us to shop for and choose our doctors. Create your medical team. The most important person on it is your general practitioner. Like all things consumer—start by asking friends and co-workers about their doctors. When you have a list of highly recommended doctors call and make an appointment for a “meet and greet.” You’ll have about 15 minutes so arrive ready to learn what you want to know.

Be prepared for this interview with a list of questions beginning with, “Tell me about yourself.” (It might be a good idea to tape it because you probably won’t remember all of it.) You should expect to learn about their schooling, attitude regarding off-office hour calls, number of years in practice and even references. Remember, you are the customer. Wouldn’t you do this if you were buying a service or product?

If you decide you want to follow up with whatever procedure the doctor suggests for a new patient, make an appointment for an exam and conversation about your health.

During the interview consider this—People like people like themselves. As you talk think about the doctor’s style. Are they direct? Analytical and so on? Find a good fit to match your behavioral style. You’ll communicate better. We all know certain personalities just don’t mesh. It will be true in the relationship you have with your doctors.

Also consider this… depending on the age of the doctor, they may have been taught to view the patient as an unreliable narrator? That means they’ll be skeptical. However studies exist with medical authors arguing for the patient-doctor relationship. A 1992 study has the authors saying the patient’s unique knowledge is just as important to outcome as the doctor’s scientific knowledge. The authors of the study say when this happens… the medical visit is truly a meeting of the experts.

2. Speak Up

In a study published in the Journal Annals of Internal Medicine, diabetic patients who were taught to be more proactive with their physicians ended up feeling healthier and actually being healthier. Within a month of learning to become more involved and willing to negotiate with their physicians, the patients showed statistically significant improvements in their blood sugar control without an increase in medication.

Doctors learn bedside manner during their schooling, so why can’t we as their patients take some responsibility for improving the relationships we have with our health care providers. Why don’t we speak up? Stop for a moment and think about the difference in mind set between doctors and patients.

* To the doctor, illness is a disease process that can be measured and understood through laboratory tests and clinical observations. To the patient, illness disrupts our life.
* The doctor’s focus is more on keeping up with the rapid advances in medical science than on trying to understand the patient’s feelings and concerns. Yet patient satisfaction comes primarily from a sense of being heard and understood.
* Many doctors do not see the role of physician as listener, but instead view their function more as a human car mechanic: Find it and fix it. Yet patients often feel devalued when their illness is reduced to mechanical process.
* Doctors feel frustrated, even betrayed, when patients withhold pertinent information. Yet patients who use alternative medicine, for example, may not tell their doctors for fear of ridicule or being labeled as flaky or gullible.

In her book, "Claiming Power in Doctor-Patient Talk" (Oxford University Press, 1998), Dr. Nancy Ainsworth-Vaughn, a professor of sociolinguistics and anthropology at Michigan State University, notes that satisfied patients often assume more control of the conversation by asking questions, changing the topic, and telling stories about their personal lives.

In her seven-year examination of successful patient communication strategies, Dr. Ainsworth-Vaughn observed that people often used verbal strategies, such as rhetorical questions and anecdotes as a non-confrontational yet persuasive way to let the physician know what they were thinking and how they were feeling.

What are you supposed to say to the health professional? What have you told everyone within shouting distance about how you, your child, your spouse, your family member feels? If it’s a first appointment with a new doctor, I suggest two approaches. If the doctor is a specialist for a one-time event – maybe heart surgery – you really shouldn’t care if you feel personally compatible. If you’re allotted 15 minutes, you need to ask how long, how many and how successful they are. If a doctor is suggesting surgery or a procedure … ask, “Would you recommend and do this to your mother?”

Afraid to speak up? Why? What do you think will happen? The doctor will fire you? I don’t think so. Remember, you are the customer and without you, they don’t have a business.

3. Be Prepared

Researchers at the University of California at Davis discovered in a study of more than 500 patients that the major determinant of patient satisfaction was “patient activation.” That means patients asked questions, initiated discussions about what was going on with their health and discussed topics of importance—even if they were unrelated to the medical visit. Improvements in patient health were correlated to how well the patients and physicians discussed the current emotional state and relationships of the patients and families.

So what good health often comes down to is being prepared and honest with your doctor.

When you have a medical appointment, take with you a clear, concise explanation of what you think are your medicinal issues. (I know, having an adult conversation when you are on the table with your bare legs dangling and a tiny paper cover up with the doctor looming over you is not easy.) Especially when you are a female and your legs are in stirrups. Are you picturing these scenarios? We’ve all been there.

Doctors are scientists. They want the facts. Instead of saying, “I think I have…” describe your symptoms in factual statements. I have been coughing and my throat is raw. My headache is here-in the front of my forehead and my sinuses are stopped up. The Internet makes us all do the research ahead of time. The doctor is the expert. Let him or her hear your problem and come to their conclusion.

Once you’re diagnosed, learn about your illness, especially if it’s chronic or terminal. It will help you understand the course of treatment and make decisions as you move toward wellness.

One of the most important things you can do to prepare for any appointment is to create and bring with you a portable medical notebook that has the basics of your medical background. I have my own medical notebook for those times when I go visit a new doctor. Our medical history is our business NOT our doctor’s property. This book should include family history, medications, past surgeries and illnesses, test results, alternative care (massage for example) and whatever else you think is relevant. Even record exercise programs and diet! Keeping these records means you’re always prepared for your next appointment, now and long into the future.

4. Own It! Your body that is!

Chances are you take care of your car, your house and other belongings.

But do you take care of your body?

Let’s think for a minute here about the three parts of the medical system. They are the patient, the physician and everything else – hospitals, insurance, pharmaceutical companies, etc. Which of these three do you think wields the power? Probably none of you guessed the patient because you have let the system make you feel powerless. But think of it like this – none of them would have a business if there were no patients. Well, how about that?! Are you beginning to get the idea about life in the “medical fast track?”

It’s not all up to your doctor and medical team to take care of you—the patient. It’s up to you!

The AMA has a Healthier Life Steps program outlined on its Web site. Cited are four key health behaviors, poor diet, physical inactivity, tobacco use, and excessive or risky use of alcohol. These behaviors are significantly related to heart disease, diabetes, cancer, and other conditions.

Do you eat right, exercise… drink alcohol in moderation? Not smoke?

How many times has your doctor given you orders when you’re sick and you disobey? How many times does the doctor offer two options: healthy living or a prescription? Which do you choose?

Oftentimes, your medical doctor doesn’t talk much about good health practices. They have been trained to cure sickness, not to keep you healthy. There is plenty of information available about good health practices, so there is no excuse for being overweight, smoking, or other known hazards to your health. I’m sure that all of you have heard the list of problems that accompany being overweight. Personally, I’ve never understood why anyone chooses to make them self sick. I find that I have my hands full just living with the effects of age and genes.

When are you going to take responsibility for your own body? Does it belong to you or your doctor? Isn’t it the most precious part of your life? Then act like it!

5. Exercise Your Choices

We all know that doctors are busy. Your doctor may have done early morning rounds at the hospital, seen 15 patients and answered other doctor’s inquiries before you appear on the scene. Is this your fault? No. (A good reason for early-in-the-day appointments.) Put yourself in the doctor’s chair.

Choose to be prepared for the doctor’s appointment.

1. Be clear and concise about your problem state what’s going on, how long have you had a problem, and if you are you taking medications or alternative treatments.
2. Don’t tell the doctors what to do: I have a sore throat, so I want an antibiotic. Tell your symptoms. Let the doctor diagnose the problem.
3. Ask next steps and options.
4. If the doctor tells you what to do (hands you a prescription, for example) ask what the outcome will be if you don’t take it, what are the side effects, what are the other alternatives and why the dosage. Have you ever questioned your doctor in this way?

Listening works both ways – choose to listen carefully, take notes and ask questions. If your doctor doesn’t seem to be listening to you, ask if the doctor has questions about what you are saying. That’s what we mean when we talk about communication.

Choose to be appreciative. Communicate to your doctor that you appreciate their expertise and are looking forward to working together to resolve your problem. Prepare yourself for the doctor to show total disbelief – they probably don’t get many compliments.

With all of the information in hand, choose your next steps. You can choose to disregard the doctor’s “orders” and suffer the consequences. You can choose to fire your doctor and shop for another one. You can choose to combine alternative care with traditional (Western) care.

Choices, options… it’s up to us to decide when armed with the right information.

None of us know what the future of our own health and the system holds individually or collectively. If we did, would we do anything differently? If you know that heart disease runs in your family, are you going to do everything you can such as proper diet and exercise to prevent it? Are we going to be more proactive about a good patient/doctor relationship? Are we going to assume responsibility for our bodies and their wellness, rather than placing all of the responsibility on the doctor?

Ask yourself: What is my role in having good health? Empowerment works both ways. The patient needs to feel empowered, meaning that you have choices and have the power to execute them. The doctor needs to feel that there is mutual trust, that you will be honest about your medications and life style choices. Only then can you chart a healthy doctor/patient relationship.

To learn more about the tour, visit http://bookpromotionservices.com/2010/04/26/sick-of-doctors-tour/. You can also learn more about Lorene Burkhart and the book at http://www.burkhartnetwork.com/.


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