How to Get What You Want from the Doctor
Good Patient, Bad Patient
Most doctors genuinely want to help you. "There's a difference between treating people and caring for people. I'd like to think I do both, and that I do the latter well," says Los Angeles oncologist Barry Rosenbloom. Many doctors do empathize with their patients, and there is no question that the issue of bedside manner is getting more attention these days. Hospitals sponsor seminars on the topic and medical journals publish papers on how to master, as Sir William Osler put it, "the kindly word, the cheerful greeting, the sympathetic look." Still, according to Rosenbloom, "Some patients' expectations are way beyond anything the doctor can deliver." In truth, both doctors and patients bring plenty of unspoken (sometimes unconscious) expectations into the examining room.
The first time you meet a doctor, it is fair to assume that he is hoping you will turn out to be a "good" patient, one who listens to him, follows his orders, and promptly gets well. Put another way, doctors have a hard time dealing with patients who don't improve. Patients return the favor—they like doctors who can heal them and dislike those who cannot. Naturally, doctors are aware of this.
In 1995, Consumer Reports published a survey of 70,000 readers who were asked about their experience with medical care. Patients with chronic headaches or back pain reported the greatest amount of dissatisfaction with their doctors. Not surprisingly, the doctors who treat these conditions "may not even want to see these patients come in the door," according to psychologist Judith Hall. The patients who were most satisfied with their medical care were those who had glaucoma, cataracts, or were pregnant—conditions that require a single or easily understood course of treatment that is usually successful. Patients were also generally satisfied with their oncologists (cancer doctors) because, although the outlook may be grim, the illness is always taken seriously. Additionally, cancer patients understand that their condition might be impossible for any doctor to cure.
Patients who get better quickly affirm the doctor's skill, whereas "chronic, insoluble problems are very, very frustrating to doctors," says Barbara Korsch. "Doctors are success-oriented; they can't see a failure. They dislike anything they can't diagnose and cure; they hate fibromyalgia, chronic fatigue syndrome. Those poor patients really suffer because doctors tend to think that if they can't find any objective signs it's probably all in the head, and if it's all in the head, instead of feeling sympathetic they become contemptuous and say, 'That's not my problem.'"
This doesn't mean you must give up hope of finding a caring doctor if you have a chronic condition. It means that, by being aware of the doctor's bias, you can take steps to overcome it. You can begin by voicing what the doctor is probably thinking, advises Korsch: "You can say, 'I realize nobody knows what fibromyalgia is and there is no cure, but I'm hoping you'll find something that will help me.' Build up the good side, the Dr. Jekyll side of the doctor. You might also say, 'I don't expect any magic. I know this is a very complex, long-standing, and partly psychological issue we're dealing with, but I'm hoping you can help with some of the most incapacitating symptoms.'"
People who are overweight also aggravate doctors, because the condition sets them up for almost certain failure. Sooner or later, one of the many diseases associated with obesity will probably show up. Like most of society, many doctors are inclined to feel scorn rather than empathy for people with a weight problem. "Curbside Consultation," a page on American Family Physician's Web site, offers advice and a place for doctors to vent anonymously. One physician confessed, "My opinion of some of these [overweight] patients has been that they are lazy, lack willpower and like being sick. At times I felt that they wanted me to give them a magic pill to cure their problem, when they were the ones who actually needed to do the work."
How do you overcome this prejudice? Korsch advises overweight patients to be candid and at the same time practice a little reverse psychology: "If it's there and real, you have to deal with it. If you're heavy, say, 'I know everybody thinks fat people are just sloppy and overeat and are self-indulgent, but I hope you won't consider me that way because I've really tried and I do want your help with it.' You can sometimes detoxify the particular stigma by bringing it out into the open, because that enables the doctor to say, 'I don't really think that.'"
The point is that the experience you have with your doctor has a lot to do with what's ailing you. Both you and the doctor will bring preconceived notions into the examining room. Both of you will be waiting to see if the other is "good" or "bad." Understanding this dynamic improves your chances of success.
Let's say you have an illness that is not life-threatening and is fairly mundane. How do you solidify your standing as a "good" patient? According to one study cited in Consumer Reports, doctors described good patients as those who appear to understand what the doctor is saying, ask few questions, and respect their time. Sadly, these are exactly the traits that keep patients in the dark. Most people have difficulty understanding the doctor's terminology, so they ask questions, which takes time.
Physicians also agree that "good" patients follow doctors' orders. Noncompliers are the bane of the profession, but the reasons patients don't comply can often be traced to bad communication with the doctor. A man might be told to take a prescription medicine he can't afford and be too embarrassed to admit it. It's common for people to be instructed to change their lifestyle—to diet, exercise three times a week, give up caffeine, and so forth—but often they just aren't up to the challenge. They fear being judged by the doctor, so they put off scheduling a visit or they lie about their progress. Are they bad patients, or are the doctors at fault for not knowing their patients well enough to advise a course of action they might actually follow?
As a patient, you have your work cut out for you. You want to be a "good" patient, one whom the doctor will want to spend time with and help. Yet you must speak up and make sure you understand what the doctor is talking about. It's like downhill skiing: the course is fast, skill is essential, and you must be sure of the terrain before you push off. The first stop on the journey is inside your own head.
From Say the Magic Words by Lynette Padwa. Copyright © 2005. Used by arrangement with Penguin Group (USA) Inc.
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