Talking to your doctor

Most people have a horror story to tell about a visit to their doctor. Be it long
waiting times, insensitivity or simply feeling rushed, most of us have at some point
had a bad experiencewith our doctor. By the same token, however,most have also
had wonderful experiences where health carers have gone out of their way to help
us, or been a great source of support through difficult times. So why this difference
in our experiences of health care practitioners? In this section we examine the
complex relationship between patients and their doctors. We look firstly at why
patient/practitioner interaction is important and also what factors affect it.
Patient–doctor communication
Aswithanysort of communication, that betweenpatients andtheir doctors is a two-
way street, with both parties getting it wrong sometimes. Unfortunately, however,
poor communication can have serious effects on a patient’s treatment. It has been
linked to outcomes as problematic asnon-compliancewithtreatment, absence from
important follow-up appointments and, in extreme cases, litigation. Furthermore,
althoughmost of us are able to recognise a case of blatant incompetence,most of us
are insufficiently knowledgeable about medicine to know how good the treatment
we have been given really is. We tend to judge our doctors less often on the care
that they give us andmore often on theway that it is given. The fact that a patient’s
first port of a call will be their local GP when they seek help for their skin condition
may raise a variety of problems. First and foremost they need to remember that
their GP is often very busy and probably under a lot of pressure to get through a
waiting-room full of patients – with the result that he or she may be less likely to
respond to the emotional aspects of their concerns. Secondly, it is not a prerequisite
for general practitioners to have any training in dermatology. Thismeans that the
GPmay not actually havemuch experience dealingwith dermatological problems.
And thirdly, many health care workers see dermatology as being at the bottomof their list of medical priorities as these conditions are rarely life-threatening and
tend to be seen as more of a cosmetic problem. Few of these problems are a direct
consequence of the doctor’s behaviour. Rather do they stemfroman overburdened
health care system where both providers and patients are put under pressure to
meet the specific demands made of them.
When doctors get it wrong
One of themost commonly reported problems is communicating. Doctors are often
rushed off their feet with busy waiting-rooms and, in fact, a famous study carried
out by Beckman and Frankel in 1984 found that in only 23 per cent of cases that
they observed were patients allowed to finish their explanation before the doctor
interrupted.
The use of jargon is another common barrier in patient–doctor communication.
In some cases jargon explanations are used to dissuade the patient fromasking too
many questions. However, a more likely reason is that the jargon that doctors use
is a carryover from their training, where they are taught a complex vocabulary
and communicate this to other professionals. They can get so used to doing this
that they forget that the patient doesn’t share their expertise. Another explanation
for why this happens is that doctors may be unclear about the amount and type of
information they should share with patients.
This is another common block in communication,whichmay be used intentionally
to keep the patient quiet and help the doctor to focus. Or it may happen uninten-
tionally, because most doctors are trained to treat the illness and not the patient.
Thus theymay focus on a skin lesion and howto cure this as opposed to considering
how the patient is feeling about it.
When patients get it wrong
Through their attitudes and behaviour, patients too can contribute to poor doc-
tor–patient relations. Patients often bring a sense of anxiety into the consultation
room and this can lead to the patient experiencing difficulties in attention and
concentration making it difficult for the patient to process incoming information.
This kind of anxiety can alsomake it difficult to retain what information is learned.Another problem that the patient can bring is the fact that they often ‘respond
to different cues’ about their conditions than do the doctors. Where patients can
often be preoccupied with the pain and symptoms of their conditions, doctors
tend to focus on the underlying illness, its objective severity and its treatment.
Patients may not understand the doctor’s focusing on factors that they consider
to be incidental to the main problem and this can be the source of tension in the
consultation.
A final problemthat can present in the consultation is when the patient fails to
give all the necessary information to the doctor, through fear of the consequences
of giving that information. In the case of skin disease a good example could be an
individual reporting to the doctor with a skin complaint on the arms and around
the groin area. The patient may be embarrassed and fail to point out that the skin
complaint is located in the groin area as well as on the arms. But this failure could
result in a different diagnosis being made to the one which might have been made
had the doctor known that the skin complaint was on the groin aswell as the arms.
A lack of feedback can be an interactive problem between the patient and the
doctor and those who do receive feedback tend to receive negative feedback rather
than positive feedback. Peoplewho have left the consultationwith a recommended
treatment that is successful are unlikely to return; but those who feel that their
treatment has been unsuccessful will return. If a patient does not return after a
treatment recommendation from a doctor, it could be for a number of reasons. It
could be a result of a successful cure. Or, the treatment may have failed but the
disorder cleared up anyway. Or, the patient could have decided to change doctors,
since the previous doctor’s recommendation failed in their eyes. Or, the patient
could have died. It is important to give good feedback when possible; this will only
improve communication between patient and doctor.

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