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Why is it so hard to talk to doctors?

May 27, 2012

It’s an almost universal experience.  You talk, they talk, yet do you feel like they heard you?  Often the answer is no.  Why does this happen so often?  Even when I feel like I’ve had a good conversation with a doctor, sometimes I realize I still have a lot of questions afterward and no satisfactory way to get them answered.  Sometimes the doctor’s subsequent actions indicate we were not on the same page at all.

I have observed doctors and worked with them as a colleague for over 20 years.  The most closely I worked with doctors was in the intensive care unit and the recovery room, both critical care areas with frequent need for consultation concerning patient problems.  I’ve watched the culture change in hospitals from allowing doctors almost any obnoxious behavior to sending them for anger management training after multiple reprimands for outbursts.  It’s a very good change.  Let me explain further.  When I began my medical career, I worked in rehabilitation and psychiatric facilities.  In these lower stress areas, the doctors were generally well behaved.  This was late 1980’s to 1990’s.  In 2000, I began working in an acute care hospital on a cardiac floor.  At that time the older nurses would recall certain physicians having tantrums that involved cursing, yelling, and throwing patient charts down the hall.  The old attitude was kind of a boys will be boys thing.

During my career I have not seen such egregious behavior.  Nursing managers now report incidents of abusive behavior or sexual harassment to the hospital administration and the Chief Medical Officer (CMO).  I have been treated abusively by doctors at times, but fairly rarely.  I have also learned how to stand up to bullying when it occurs.  I have more confidence in myself and my experience.

Now this is generally a “behind the scenes” type of interaction that patients rarely witness, but it speaks to a culture that is changing, but slowly, in which doctors were placed high above their colleagues who provided most of the care for their patients and even higher above the patients.  Not so very long ago it was permissible for doctors to determine treatment without consulting their patients or even notifying them of the risks.  Patients weren’t expected to question their doctor’s decisions, much less seek information about their condition from other sources.

Things are much different today.  Regulations and laws requiring informed consent for treatment and procedures are widespread.  It is expected and required that physicians will be truthful with patients.  Lying for “your own good” is no longer permitted.  There has supposedly been more emphasis on teaching communication skills in medical school.  So why does the disconnect between doctor and patient still occur with such regularity?  I think there are several aspects to this problem that need to be examined.

One problem is time.  Doctors are under tremendous pressure to see a high volume of patients every day.  Low reimbursement and high overhead contribute to this problem.  Consider also the high debt load of most physicians upon completing medical school.  So they are rushed.  That makes it hard to listen.  In his book, Your Symptoms are Real: What to do when your doctor says nothing is wrong, Dr. Benjamin Natelson discusses the doctor-patient disconnect in some detail.  He quotes a study that determined that on average, doctors only listen to their patients 18 seconds before interrupting and taking over the direction of the conversation (Beckman and Frankel, 1993).  Another result of the high volume/time pressure issue is that many doctors give only a cursory explanation of their proposed treatment plan and fail to properly educate patients about what that plan will require of them.

Another problem, from my point of view, is the lack of trust many doctors have in their patients.  I recently went to a clinic that serves primarily low income people.  The doctor did not take a full history from me, only wishing to discuss records I had brought with me.  She then said she didn’t want to do anything else until she received records from all my previous doctors.  At a later visit with my husband, she actually contradicted what he told her about the treatment plan of one of his other doctors by reading the visit note from an appointment several months before out loud to him.  When my husband tried to explain that he had had several more visits with that doctor, she walked out of the room.  Needless to say, we are firing her.  This is an extreme example of course. What happens more commonly is doctors withholding bits of information because they don’t want you to worry about something they consider insignificant.  It’s eye opening comparing what your doctor tells you to what you read on a procedure or test report. Another thing that happens with some doctors is that they discourage patients from researching their condition.  One person I know says she was instructed by her doctor to “trust more, read less.”

That last example suggests another problem.  Lack of respect for patients.  That was certainly present in those interactions I described with the clinic doctor.  More often there is the more subtle “one down” relationship of patient to doctor.

A huge problem from my point of view is the near impossibility of receiving accurate and helpful answers to questions if you are not physically in the room with the doctor.  In reality, important questions can come up between office visits.  These may be regarding side effects of medications or a change in symptoms.  Also sometimes when we get home from the doctor, what they said seems less clear or we remember a question we forgot to ask.  In my experience, calling the office with a question (especially specialists’ offices) results in getting back a generic answer that may or may not apply to your case and may not be helpful.  The other scenario is when the answer some one calls you back with makes it clear that the question was garbled in translation.  Sometimes medical assistants who are not trained to understand the significance of test results tell you something is fine because the doctor signed it, missing an important nuance that could affect your condition.  Almost never will a doctor actually talk to you on the phone any more.  I’ve essentially given up calling and either try to find the answer myself, wait for the next visit, or if it can’t wait to to schedule an earlier visit or just go to the ER.

I am not saying all these things to denigrate all doctors.  Some doctors do a good job of listening, answering questions, and explaining the treatment plan.  Unfortunately quite a few don’t and we pay the price.

3 Comments leave one →
  1. May 27, 2012 10:55 am

    The whole arena of poor communications between doctors and patients triggers anxiety in me. It is the nutshell that my post traumatic stress disorder (PTSD) hangs out in. Trusting and being trusted seem like they should be cornerstones to good, if not excellent, care.
    And I’ve had some rare and treasured experiences with doctors who are actually therapeutic as well as intelligent “black belt” dynamos in their specialties. I know that these good doctors actually exist. Maybe that’s partly what makes it so very frustrating to deal with the poor communicators, the doctors who mistrust every word that comes out of my mouth

    I have been treated with mistrust by more doctors than have been respectful and/or trustful of me as a patient. It seems that the body language speaks louder than words at times. I have talked with a multitude of women, in particular, who relate the eye-rolling behavior of doctors who write us off as they enter the exam room. What is is they see? A fat woman with heart disease that she caused herself, who is likely to be noncompliant? Do some of them make the wrong assumption that because we are women, we’re not too bright? Do they feel that they need to “dumb it down” for us? Are they just sexist? And why am I taking up so much time trying to figure this out?

    I believe in the inherent dignity and worth of every person. That’s how I was brought up.
    The vast experiences I’ve had in the patient-doctor and the nurse-doctor arenas have shown me that many doctors were perhaps brought up differently. Wouldn’t it be a lot easier to “vet” our doctors if there were some easy to understand assignation, like “non-compassionate” or “no compassion here” that each doctor had to put next to his/her name?
    Maybe a few would have another assignation-“willing to listen”, or “believes in YOU”.
    Then we could avoid wasting our time being berated, mistrusted or abused.

    I could go on,,,,

    Love,
    frykwoman

    • May 27, 2012 11:19 am

      Natelson talks about the 3 B’s: Brash, Boorish, and Overbearing, and the 3 C’s: Compassionate, Caring, and Creative. He also mentions a 4th C, Curious. So maybe it could be So And So, MD, PA, BBB or Nice Doc, MD, FACS, CCC-C. LOL.

  2. Ruth Kivela permalink
    May 28, 2012 5:03 pm

    I found all of this article relevant. Especially to my last oncologist. Ño info given on the down side of cchemo. No treatment for radiation burns. No good treatment suggestions for cardiac follow up. Denial of echocarrdiogrram results. Tine for a new. Doctor.

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