Physicians and Patients—Partners in Care

When we think back to what medicine looked like 50 years ago, the landscape looked very different.  Not just because medicine has developed so much in the last 50 years, but because the way patients and doctors interact has changed.  The age of paternalism is over—doctors used to tell patients what to do and then patients would do what was recommended.  There were fewer questions asked and there was less discussion had.  This week in The Doctor Is In we will explore what’s changed in communication between doctors and patients and talk about ways to ensure both patients and physicians get what they need out of an appointment.

One of the biggest changes to medicine in the last half century wasn't even a medical development—it was the arrival of the internet.  With the internet and associated devices like smart phones and laptops, information that could previously only be looked up in books at the library are now available with a few thumb strokes.  Patients have much more information available to them.  And with more information will come more questions, thoughts and opinions about your options.  

As information is more available, communication becomes more complex because there is a larger field of engagement.  This is why we now see the age of patient-centred care. With patients being able to better understand their health, they are better able to choose what will work for them and what may not.  They can ask better questions of their doctors to ensure they understand what is going on.  This in combination with the fact that medicine is more technologically advanced means that appointments can take longer now before patients feel confident that they understand next steps.

While communication is more complicated, it also has the opportunity to be more in depth than it ever has been.  We have the opportunity to truly partner with our patients in their care.  We can provide clinical context and expertise while patients provide the expertise of who they are as people.  If there are three treatment options, I can give you the options based on what makes most medical sense, but then the patient can join in that conversation and let me know which of the three options makes the most sense for them.  A treatment plan is only as effective as how it is implemented.  That is why the doctor’s opinion and patient’s opinion are both important.

In the age of information, there can sometimes be tension between the patient and the physician.  Patients often times have a specific idea of what is going on with their health when they arrive at an appointment and become frustrated if the doctor appears not to agree.  Or sometimes the physician might make a recommendation that the patient has read about previously and has concerns with.  Because of this, the quality of our communication matters more than ever.

I offer the following three pieces of advice for all patients and physicians to improve communication between them:

1. Assume good intent from each other

2. Understand that medical assessments start broadly, not specifically

3. Ask each other to explain what you understand if you aren’t sure the other person is getting it

Assuming Good Intent:

It is important for both patients and physicians to assume good intent from the other person in a clinical interaction.  Sometimes patients are worried that the doctor is just trying to rush them out the door instead of listening to their concerns.  Sometimes doctors are concerned that a patient is coming in just to ask for a specific medication instead of allowing for a full medical assessment to analyze their symptoms.  

These types of assumptions can automatically put you on opposite sides of a problem.  If instead, we assume that the patient is there to receive care and the doctor is there to provide it, the appointment starts off with everyone on the same side.  It is easier to move forward from there.

Assessments Start Broadly:

In the age of information, patients often have an idea of what they are experiencing prior to attending their appointment.  It is rare that I have someone book in for an appointment where the reason for visit is burning with urination.  Instead, most of the time, it is written as a possible urinary tract infection because the patient already has an idea of what is going on.  

But a physician’s job is to ensure that they rule out other types of diagnoses, so that means even when a patient is sure of what they are experiencing, a doctor is obligated to ask other important questions such as if there is pain in their back or sides to indicate a kidney infection or if there has been any recent unprotected sexual activity which could increase the risk of a sexually transmitted infection.  Physicians asking other questions is not about doubting the patient’s understanding of their symptoms—it is about being thorough on their patient’s behalf.

Ask For Explanations to Ensure Understanding:

When I was starting out in medicine, I would often ask, “Do you understand” after I finished explaining a concept or treatment plan.  But I started to notice that I rarely received any answer other than yes.  And there was no way that I was explaining myself perfectly 100% of the time.  It was then that I realized that we often times will say we understand something but the person I am speaking to and I may understand two very different things.  

That is when I started asking patients to explain it to me.  “Tell me what you understand about this treatment” will get you a much more accurate answer than “do you understand?”  And it works for patients as well.  The number of times I have heard a patient say, “they didn’t listen to me” or “I don’t think they get my symptoms” is countless.  So I started to reflect back—“this is what I understand about your symptoms” and go on to explain what I heard, giving my patients the opportunity to correct me if I am wrong.  If you are in an appointment with your doctor and you aren’t sure they understand your symptoms, ask them to explain them so you can both be sure you are on the same page.

The information age has complicated the physician/patient relationship for the better.  We see real conversation and truly patient-centred care being the priority across the healthcare sector.  It is incredibly exciting to see patients engaging in their care as partners rather than as passive participants.  Communicating with each other will remain our strongest tool for getting to the root of someone’s health concerns.