Establishing the Doctor/Patient Relationship
By Edward Kowaleski, Primary Care Provider
Getting to know you
As corny as it sounds, the words Anna sings in "The King and I" are at the heart of a good doctor/patient relationship. "Getting to know you, getting to know all about you" is the first thing I must do as a primary care provider. Knowing you is an obligation on my part. How else can I possibly treat your diseases? Knowing you is my obligation and that implies you have an obligation as well. You must be willing to tell me about you.
My Responsibilities to the Patient
As a doctor I must be prepared to treat you. People seem to have some strange idea that getting prepared was easy. Here is a short list of what I do to be prepared:
- Be dedicated to wanting to be a doctor
- Getting educated which includes years and years of formal schooling, an internship and a residency. After all the schooling I must prove I am capable to be a doctor and I must become board certified in my specialty.
- I must continue my education for as long as I practice by staying current on all the latest medical information.
- Not only must I stay current on the latest medical news, I must stay current on the latest technology and how it applies to my practice.
- I must have a place to work and treat patients and I must have skilled staff to assist me
- I must be willing to give the best advice available
I took an oath to do all the above. So did my medical peers.
I have other responsibilities as well. I must have good record keeping habits. I must keep both your medical records and your financial records safe and secure.
The above are my responsibilities to the patient. The patient has some serious responsibilities as well.
The Usual Circumstances
Let me start by saying that many times misdiagnosis is not the fault of the doctor. I cannot look at a patient and through some arcane science divine what sickness is afoot. I have to ask questions, test and examine and, by a process of elimination, determine what is the most likely cause of the problem. Then, and only then, can I prescribe a course of treatment, which may include sending the patient to a specialist. If the patient is not completely forthcoming for any reason, including fear, my chances of an accurate diagnosis are diminished.
Medicine is not by guess and by golly.
Having stated that, it is necessary for the patient to have a realistic understanding of what I can and cannot do and to not have unrealistic levels of expectation. For instance, I cannot, on our very first meeting, get a completely accurate picture of your total health requirements. I know nothing about your lifestyle, eating habits, exercise habits, work habits, temperament or medical history. Add to that the patients' usual unhappiness at having to see me in the first place and apprehension as to the outcome of the visit and you have a situation that is really not very desirable – for either of us.
A level of trust must be extended on both parts. You, as a patient, must trust I have your best welfare at heart and I am skilled and capable of treating you and I must trust you are telling me, as they say in court, the truth, the whole truth and nothing but the truth. And you tell me all. Otherwise, I might not be able to look for the right thing.
The Patient Responsibilities
You have to fulfill your part of the bargain. Following doctors' orders is certainly harder that the doctor giving the orders. This is especially true if the orders are those very things you least want to do, like exercise and diet. Patients with chronic diseases are almost always told to exercise and diet. Have diabetes and heart disease? If you don't exercise and diet, what makes you think I can be effective in treating you? You are not living up to your part of the deal and fulfilling your responsibilities. So why are you coming to see me?
Do you take your prescribed medicine exactly to order? Many patients start to feel better a few days after treatment starts and stop taking the medicine, even if it says to take until the medicine is gone. Their reasoning is by feeling better they must be better. This is not so. There is a reason why drugs are prescribed the way they are and it is necessary to take them exactly as ordered. Doctors do not prescribe drugs for the doctors' health. If you are not willing to follow the orders exactly, why did you come to see me?
My magic wand is broken. The magic incantations don't work. The runes, hexes and symbols are all out to lunch, permanently. Nope, all that is left is good medicine and that means the following of the instructions. It may not be pleasant but it is necessary.
The patient has to live and follow their responsibilities. For instance, even in just going to see me, it is helpful, and will save a load of time and aggravation, if you bring all of the following:
- A list of your medications and their directions for use (you should always carry this list in case of emergency)
- A list of all the items you wish or need to discuss
- Preparation to tell me exactly your ailments
- Preparation to tell me exactly how you have followed your medical orders
- Preparation to tell me if anything out of the ordinary has occurred since our last visit and the frequency of those occurrences
- Preparation to tell me about other doctors you are seeing and what treatments you are receiving from them.
- Any changes that may or may not be germane to our visit.
- Arrive a little early to ensure any paper work can be completed before the appointment.
- Arrive a little early so my assistant nurses can take your vitals prior to my getting to the examining room
The better you are prepared and the more you can tell me, the better for both of us.
There is another reason why you need to be prepared and I am afraid it is a sign of the times. I have only so much time I can spend with any given patient. The average doctor can see only about thirty-two patients a day and that is a demanding workload. We are allowed only fifteen minutes with a patient for a normal visit. This is not much time and puts an unfair strain on both the doctor and the patient. I need to spend the time to examine, test, diagnose, update the records and prescribe. It is a lot to do in so short a time.
If you are not prepared well, you are not prepared and the system implodes. This means your irresponsibility hurts others. Think about this for just a moment. If I am short with you because the system is imploding, you do not like it and start to believe I do not care about you.
I recognize we will probably never be friends. That does not mean we cannot be friendly.
I promise I will always be prepared as I can possibly be. Will you?