DOCTOR-PATIENT RELATIONSHIP

What do patients want? Most complaints by patients and the public about doctors deal with problems of communication not with clinical competency.The commonest complaint is that doctors do not listen to them. Patients want more and better information about their problem and the outcome, more openness about the side effects of treatment, relief of pain and emotional distress, and advice on what they can do for themselves. Several studies have clearly shown that doctors and patients have different views on what makes good and effective communication.These differences influence the quality of interactions between doctors and patients, as well as compliance, patient education, and health outcomes.

Doctors are very busy, unfortunately, overworked, and while he or she would probably like to spend more time with you and each and every patient, it is important to be prepared and spend your time with your physician wisely and efficiently

When consulting a doctor, try to present a detailed and well-organized account of present symptoms and relevant past history. Before contacting the doctor, it may help to draw up a list to guide your presentation. If there is more than one problem, start with the most important one. If you have a particular concern, bring it up at the beginning of your visit. If medications are being taken, either write down their names and dosages or bring the original bottles to the appointment. Since patients typically forget much of what they are told in a doctor's office, taking notes (with the doctor's permission) might be helpful.

Physicians know much more about medicine than lay people do but are not always good communicators. They may be authoritarian or even patronizing. Patients should not accept this behavior. Consumers have the right to be partners in their care and to receive a clear explanation of the physician's findings and proposed treatment. There is no good reason why a physician cannot provide this. A friendly comment that you want to be able to follow the physician's advice properly usually establishes the desired relationship.

Multiple factors impact the effective communication between a doctor and patient, but a central issue is the lack of time — both real and perceived. Of course, it is true that even under ideal circumstances some physicians have better “bedside manners” than others, but it is also true that the communication gap between doctors and patients has been aggravated by many of the pressures of current medical practice. For example, physicians are expected to see more patients over shorter periods of time, and the need for efficiency is sometimes confused with avoidance of open-ended communication between the doctor and patient. This can be made worse by the use of technologies, such as the electronic medical record or imaging, that permit the doctor to view the patient through a different lens, the net result of which is less direct and personal contact and connection. Medical practice has also shifted to physician work schedules that sometimes impact continuity or doctors’ ability to form a personal relationship with her or his patient. Further, physicians in training don’t necessarily have good role models or teachers about the art of medicine (which includes listening and communicating). Generational differences in how doctors carry out their work and how they view medicine as a profession or a job add to the mix of issues and complexities. Listening to the patient is not the same as simply asking questions and getting answers. It begins with allowing patients to tell their stories — and 

have the time to do so

We need to rediscover — and to teach — that the vast majority of medical diagnoses can be made with a well-done history, complemented by a physical exam and supported by selected laboratory and imaging studies. This simple concept needs to be given much more value and attention in the education of medical students and postgraduate trainees. During the last decades, too much emphasis has been placed on getting as many tests as possible to rule in or out various diagnoses rather than seeking the simplest and most cost-effective way to making a diagnosis.

All patient-doctor interactions are influenced by the expectations of both parties. If the 

doctor has unfair expectations of the patient, or the interaction is affected by bias or 
unfair judgment, then an effective relationship will never develop. Likewise, if the 
patient’s expectations of the doctor are not met, the patient will not develop enough 
respect or trust for the physician to accept his/her suggestions. The patient must feel at 
all times that they are treated with respect.  Doctors expectations of their patients 
should be fair, unbiased and without judgment.