Thursday, June 4, 2009

Doctor-patient relationship:

Can you hear the tension in this encounter? Why are doctors and patients so often at odds? Why are both expressing more frustration and less satisfaction? This is what research has to say about doctor-patient relationship:

If you’re wondering why so many hospital visits turn into a tug of war, it’s partly because doctors and patients are on different ends of the rope.

• To the doctor, illness is a disease process that can be measured and understood through laboratory tests and clinical observations. To the patient, illness is a disrupted 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.

Patients aren’t perfect either.

Some patients described as “frustrating” by doctors:
• Do not trust or agree with the doctor.
• Present too many problems for one visit.
• Do not follow instructions.
• Are demanding or controlling.

It has been observed that:

• Patients who use the doctor as a scapegoat for their anger at the illness are less likely to get good care

• A patient who is consistently rude and irritable will almost certainly not receive the same medical care as a patient who conveys more positive attitudes.

What must the doctor do to improve the relationship?

• Doctors must cultivate a patient-centered partnership. The patient desires to be known as a human being, not merely to be recognized as the outer wrappings for a disease.

• To improve patient compliance, work on mutual trust.

• Research confirms that the health of the doctor-patient relationship is the best predictor of whether the patient will follow the doctor’s instructions and advice.

• Respect patients as experts in the experience of illness.

What must the patients do?

• Be willing to demonstrate the attitudes that you want from your doctor. For example, if you would like more give and take in the relationship, demonstrate your own flexibility by offering to negotiate and make concessions. Patients can be a powerful agent for change of a physician’s behavior.

• While medical science has limits, hope does not. If a patient is ready to be helped, even a little, and grateful for the marginal, it enhances the doctor’s commitment to fostering a relationship between equals. Only such a relationship, bonded by understanding and respect, can deepen into a true healing partnership.

• Accept realistic treatment goals. Many chronic diseases can be managed, but not cured. In this age of hype, patients have come to expect the impossible; Doctors frequently grope in the dark, not because they are delinquent in learning, but because the science is not there. But even when a cure is impossible, healing may be possible

In spite of all these problems, there is reason for hope. Yes, doctors and patients will always be on opposite ends of the healthcare system, but that doesn’t mean they can’t pull in the same direction


  1. It is true that docors and patients are at loggerheads most of the time, at least in Bhutan. However, I feel that both the doctor and his/her patients actually have the same goal - the treatment and cure of the patient.

    Without going into a detailed 'analysis' I would like to offer one reason apiece from the side of the doctor and the patient. The doctor is always right and believes that the patient doesn't know anything at all about the ailment and as such, the patient need not be consulted or brought into cofidence in prescribing the course of treatment. The problem from the side of the patients is - impatience. On the other hand, the patient expects attention and treatment of a magical nature from his doctor. S/he believes as if s/he is the only patient that the doctor has to deal with.

    My two cents!

  2. Never go to a doctor whose office plants have died