I don’t trust my doctor. I don’t trust my patient.
Therein lies the rub.
The doctor/patient relationship is stressed. It is an unfortunate circumstance because doctors are and will continue to be the frontline for most patients facing chronic diseases. Ultimately, 67% of the patients doctors encounter will end up with diabetes, heart disease, obesity or a combination of all of them.
An edited version of this blog was posted on MindBodyGreen; http://www.mindbodygreen.com/0-8941/i-didnt-trust-my-doctor-but-i-was-a-terrible-patient.html
The doctor is in a position of influence and patients generally anticipate the advice dispensed as gospel. However, as the health care system bogs down, doctors have a very limited time to diagnosis and treat patients.
Today the average primary-care doctor in the U.S. is responsible for about 2,300 patients. At so-called Medicaid mills—clinics that see mostly poor patients covered by state Medicaid plans—panel sizes can reach 3,000 per doctor.
Today visits are still short, while treatment regimens for common conditions like diabetes and heart disease are more complicated. The number of required tests and conditions primary-care doctors are supposed to screen for has skyrocketed. It’s estimated that a doctor with a panel of just 2,000 patients—and without a strong primary-care team—would have to spend more than 17 hours a day providing all of the recommended care.*
This is not a recipe for optimal care. One Canadian and U.S. study found that doctors interrupt their patients on average within 23 seconds from the time the patient begins explaining his symptoms. In 25 percent of visits, the doctor never even asked the patient what was bothering him. In another study that taped 34 physicians during more than 300 visits with patients, the doctors spent on average 1.3 minutes conveying crucial information about the patient’s condition and treatment, and most of the information they provided was far too technical for the average patient to grasp; disconcertingly, those same doctors thought they had spent more than eight minutes. In another study, three out of four doctors failed to give clear instructions on how to take medication. When asked to state medication instructions, half of patients have no idea what they are supposed to do. A Markle Foundation survey released last year found that both patients and doctors agreed that about 30 percent of the time doctors forget important information their patients tell them. And in a now-famous study of physicians’ performance, patients received only 55 percent of recommended care for 30 different medical conditions. *
So as more and more Americans acquire chronic diseases, fewer doctors are expected to treat sicker patients. And they are expected to do it within 15 minutes of meeting the patient. It is not a success model.
The pressure eventually causes tension between doctor and patient. The patient realizes the doctor is busy and rather than have a unrushed discovery process; encapsulates their issues into a few details. The doctor who is on the clock, rushes to a diagnosis and seeks the fastest route to a solution; medication to treat symptoms.
Patients trust doctors. It is implied. It’s like stepping on an airplane and seeing a pilot. Doctors are in a position of trust because they have studied and dedicated for years to be in that spot. Unfortunately, a vast majority of doctors lose all their credibility the second they reach for the prescription pad. The pad represents a blanket solution and identifies the lack of creativity or engagement the doctor has with the patient. An effort has to be made in those 15 minutes to present a course of action unique to the patient. Perhaps the course of action involves medication but it should also outline an overall objective towards prevention of the root cause. The plan should incorporate short-term goals and endpoints. Versus; “you will be on these medications the rest of your life”.
Patients need to be accountable. One cannot expect a doctor to unwind years of neglect in a single visit. The onus is on the patient. A cardiologist remarked to me, after discussing my plan to attack heart disease; “I don’t have a lot of patients like you, that have made a 180 degree change. Most of my patients ask me why they have to quit smoking and eating steaks after I put stents in them.”
Doctors are skeptical and rightly so. Imagine a typical day of patients, filling the office with obesity, diabetes, and heart disease. All largely preventable diseases. The doctor suggests they eat better and exercise. Deep down they know the only possibility to relieve the immediate health risk is to seek the most expeditious solution; medication. After all, if the doctor did not prescribe medication to the high risk patient. And sent the patient home to go for a jog, they would be sued when that patient dropped dead of a heart attack.
It’s about Trust. Doctors need to do a better job of slowing down the situations and customizing therapy. And once they have charted a course of action, follow-up in a personal fashion. Patients need to take control of their own health. They need to become their own “CEO’s”. When they meet a doctor, they have to provide a thorough and honest assessment of their situation. And be honest in their ability to make changes in lifestyle. There is no room for skepticism in the doctor/patient relationship. It creates a dishonest and ineffective communication.
I trust my doctor because they trust me.
Shannon Brownlee – Newsweek
“The Doctor Will See You-If You’re Quick” Apr 16, 2012