by Pauline Salvucci
Your medical care is a two way street. In a good doctor patient relationship, you and your physician are accountable to one other. You have a right to good healthcare -- and you have a responsibility to get it. Distinguish yourself in the all too familiar world of impersonal healthcare and learn how to be your own best advocate.
You may not think of your relationship with your doctor as a dance, but it is. When you and your physician are in step with one another good things happen. Your doctor listens to you, makes a diagnosis and offers information about your condition and its treatment. You feel free to ask questions, request more information and discuss your treatment options. You respect and satisfy your need to understand your medical condition so you can follow through with the treatment that's best for you. Together, you and your doctor form a partnership that focuses on your healthcare needs and meets your expectations.
However, when you and your doctor aren't in step, important questions often go unasked, adequate information is not always forthcoming and alternative options may not be examined. If you and your physician don't communicate openly and freely, perhaps it's time to examine what's keeping the two of you out of step, how this can negatively affect your healthcare and what you can do to change it.
Are You And Your Doctor Out of Step?
You have a responsibility to take an active role in your healthcare. If you don't know how to do this, you're not alone. Many people have difficulty seeing themselves as partners when it comes to working with their physicians.
Anxious, fearful or uncertain, some patients don't share enough information with their doctor. Others rarely ask questions, thinking they "should" do what their physician saysÐno questions asked. On the opposite end of the spectrum are patients who don't comply with treatment and have repeat office visits because their condition or symptoms continue to persist. Still others follow their treatment plan in a hit-or-miss fashion. Without understanding the ramifications of not taking medication as prescribed, or failing to following their treatment plan, these individuals put their health in jeopardy. Whatever the reason, patients who are passive partners in their healthcare bear responsibility for being out of stepÐwith themselves and their doctor.
But many doctors are also out of step. Driven by expectations and constraints from insurance companies, managed care and the overall high cost of healthcare in today's competitive market, doctors are overwhelmed, tired and frustrated. This takes a hefty toll on their ability to listen to and effectively communicate with each and every patient. In addition to this, most physicians have been trained in a biomedical model and have little or no training from a biopsychosocial perspective. They often don't consider that how they communicate with patients is at least as important as what they communicate. Doctors who don't take the time to help patients understand their medical problem and its treatment are out of step with those patients.
All of us have different communication styles. Sometimes they match, but more often they don't. When communication problems arise between a doctor and patient, the doctor has the opportunity to help the patient become an active partner in their healthcare. This means helping patients get in step with their treatment plan and communicating with them in a way that fosters their success. When this doesn't happen, both doctor and patient suffer the consequences.
The Consequences of Being Out of Step
When problems surface because a doctor and patient are out of step, the result is costlyÐfor everyone involved. The drain on the individuals as well as the larger healthcare system is enormous. The following reflects some of the negative fallout when mutual communication isn't a priority:
- Patient non-compliance -- it can become a bad habit
- Repeat visits due to non-compliance -- frustrating for the doctor and the patient
- Increased healthcare costs to employers and employees -- we all pay the price
- Unmet patient needs and expectations -- loss of confidence in the physician
- Frustration on the part of the doctor, patient, the patient's family, the employer -- unless there's a plan to turn this around, tensions increase as more people become affected
- Lack of mutual respect and trust -- does anyone really care?
- Additional medical complications -- who needs it?
- Continuing patterns of miscommunication leading to dissatisfaction and mutual resentment -- doctor and patient may give up on one another
- Patient complaints of inadequate care -- this could have been avoided!
Learning New Steps
It took an experienced and savvy physician named Peter Farmer, M.D., from San Diego, California, to find a way to help physicians and patients learn the steps to promote collaborative communication. Dr. Farmer offers an assessment tool developed by TTI Performance Systems. Similar to the assessment companies use with employees to determine their communication styles and strengths, the PCI or Patient Communication Index, is an easy to use and accurate tool that offers both doctor and patient immediate feedback about their communication styles and strengths.
Here's how it works. The PCI assessment is composed of 12 groups of four words. Patients assign a number from one to four, ranking the importance of each word. This takes 10 minutes. That's it. There are no right or wrong answers.
The following is a result of the PCI assessment taken by a middle-aged female -- me. This is the feedback I received when I took the PCI. The physician directives that are included are for my doctor.
Patient's Basic Style:
"Pauline relies on structure and specific methods to gain results. She may tire you with details and detailed questions to achieve a level of knowledge that is comfortable for her. She will communicate in a friendly manner and will not dominate conversation unless details and information are being sought."
- Present a complete and detailed care plan with logical procedures and specific follow-up dates.
- Allow time for questions and explanations so that she thoroughly understands the plan.
- Be personable, but never stray from the "meat" of the discussion.
- Encourage and reinforce her by using specific examples of appropriate behavior.
- Make changes in plan sparingly, and always with thorough explanation.
You just read the result of my PCI. When I read it, my immediate reaction was -- bull's eye! The assessment is absolutely accurate and perfectly describes me as a patient. The physician directives are also right on the money. My doctor and I communicate very well, yet, I found the PCI assessment both affirming and satisfying. It confirmed the benefits of working with a physician who's in step with me.
Synchronizing Your Steps
The result of this simple assessment clarifies the degree of information that a patient wants and it offers the doctor a communication match with the patient. The benefits are significant. The patient feels that the doctor "gets" who he or she is because the information satisfies the patient's need to understand their condition and its treatment. Simultaneously, the physician receives clear information about the patient's communication style. Therefore, the physician understands how much information to share with a patient -- and the best way to share it. You and your doctor can work together. The benefits of the PCI are substantial. Here are some of them:
- Focused attention on the patient's primary needs -- expectations are satisfied
- A collaborative doctor patient relationship -- communication is open and free
- The elimination of miscommunication -- builds mutual respect and trust
- Increased mutual accountability -- fosters treatment compliance
- Responsible treatment compliance -- improved health and/or better coping mechanisms
- Greater patient awareness and assertiveness -- reduced stress when interacting with the larger health care system if tests, hospitalization or specialized treatment is required.
Be Your Own Healthcare Advocate
Consider your relationship with your doctor. Could it improve if both you and your physician had the right steps to help you work with one another? If your answer is "yes" --consider the following questions:
- Do you need to ask more questions or get clearer information from your doctor?
- Do you need or want a better understanding of your treatment plan?
- Has your doctor discussed all your options with you?
- Do you tell your doctor when something is unclear or when you don't understand what he or she says?
- Does your doctor answer your questions in a way that helps you to understand your condition and its treatment?
- Are there somethings you don't like about the way your doctor communicates with you?
- What are these things?
- Share them with your doctor -- and give examples.
Taking these steps will help you become your own best healthcare advocate. Making changes often causes us to feel awkward or unsure. That's why change takes practice. If you are uncomfortable doing this, that's OK -- do it anyway. Taking action on your own behalf is practicing good self-care. As you and your doctor improve communication with one another, you're not only making your healthcare a priority, you're also giving your physician the opportunity to be a better healthcare provider and partner.
Pauline Salvucci, M.A. was a former licensed medical family therapist.