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Influence, Power, & Politics

Are You On The Case When It Comes To Your Healthcare?

Patients often fail to remember what their doctors say to them, a physician reminded me this week.  Research supports his observation.  Yet only rarely do doctors actually write down their recommendations.  End-of-visit reviews of diagnoses and treatments are scarce.  As a result, too many patients leave their doctors’ offices unsure of what was decided and what they should do next.

Part of the problem is dysfunctional “framing” or the perceptual schemata we use to guide our decisions and actions.  Word choice, length of discussion, eye contact, facial expressions and hand gestures are among the ways doctors create frames that influence patient experiences.  Vocal tone alone may cause a doctor’s well-intentioned advice to seem condescending, resulting in a patient becoming upset or defensive.  

The endeavor to create a constructive doctor-patient frame for interaction is made more difficult by the constraints on time doctors can provide to patients.  For this reason alone, patients should become aware of how their doctors see them and how they themselves participate in building a doctor-patient interaction frame.

Gender, for example, can lead to problems in the treatment of heart disease.  If you are a female cardiac patient or at risk for cardiac disease, it’s particularly important to know how your gender may affect your physician’s choices.  Similar gender issues exist for the treatment of stroke.

For a good start in influencing how your doctor relates to you, look at some entrenched frames into which doctors can easily slip unless you guide them to do otherwise.

Lecturing doctors tend to go off on soliloquies.  They may intend to provide helpful answers, but they fail to remember that the best answers only emerge from asking the right questions.  Many of these doctors are Patronizing – although often inadvertently so.  They don’t sense that in their tone and wording they’re talking down to patients.  By so doing, they stifle many patients and thus damage the relationship that can be crucial to obtaining a good medical outcome.

Defensive doctors don’t like being second-guessed.  They reveal this in vocal tone, terse answers or nonverbal expressions of annoyance at any kind of challenge.  As with styles that become routine over time, doctors may not realize that they’re being defensive.  Some have been listening to other doctors for years.  They only hear that they sound like some of them.

Other doctors act as Partners right from the get-go.  While this doesn’t mean they are friends to their patients, they truly want to hear what those patients have to say.  The most responsive often have spent time as patients themselves, and thus can empathize with the challenges of dealing with illness.  They spend at least as much time asking questions as they do giving advice and prescribing treatment.  In short, they’re both curious and concerned. 

If you have a lecturing, patronizing, defensive, or closed-minded doctor, consider making a change.  However, be sure to examine your own contribution to the relationship, so you can avoid creating a similar dysfunctional frame with your next doctor.

Here are some comments that can help your doctor understand that you plan to take an active part in your healthcare:

“I find it useful to take notes on what we discuss here and what I should do when I get home.”

            “I did some research before coming today and I have a few questions.”

            “There’s something you said earlier that needs some clarification.”

            “I have some additional information that could make an important difference.”

            “Before I leave, let’s quickly go over what you’ve recommended.”           

Involved patients tend to be more satisfied with their care. They gain a better understanding of their condition and treatment options, and are more committed to therapeutic regimens. Thus, your doctor is also likely to benefit from your interest in your own care.  No, you’re not looking for the nicest doctor in town, but rather one who is a good communicator.  

When it comes to your health, you’re the expert in charge.  You know your body better than anyone else.  The best doctors will participate with you in this frame.  Find yourself one of those doctors.  It can be an important step on the path to wellness.

photo:  Alexander Raths/


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