Developing a Partnership with Your Doctor
By Bruce Campbell
[Third of a four-part series.]
Chronic illness calls for a different relationship between patient and physician than is usually the case in acute illnesses. Because your condition is an ongoing one in which you are the day-to-day manager, the patient/physician relationship is more appropriately a partnership.
It is reasonable for you to expect some things of your doctors. You have a right to providers who know about your illness or are willing to learn about it, who believe your illness is real, who treat you with respect and who are willing to experiment to find treatments that work for you. You have responsibilities as well. You should have realistic expectations, seeking not a cure but help in feeling better. Also, you should treat your visits as professional meetings and prepare for them.
This article contains some suggestions for making this important ongoing relationship a productive one. It summarizes advice about doctor/patient relationships in Living a Healthy Life with Chronic Conditions.1 That source suggests that to get the most from your visits with the doctor you "take P.A.R.T." The letters, as we'll use them here, mean Prepare, be Active, Repeat, and Take action.
Your doctor is an important ally in your effort to live well with your illness. If you have found a physician who fits the criteria mentioned above, someone who is supportive and wants to help you feel better, the biggest obstacle to a productive relationship is time. Particularly now in a managed care environment, doctors work on a tight schedule that often leaves them as frustrated as patients. By viewing your visits as professional meetings, you can structure your time with physicians to be productive.
Before going to the doctor, prepare an agenda. Ask yourself why you are going and what you hope to accomplish. Are you seeking a diagnosis to explain new symptoms? Would you like a new medication? Do you want the doctor to submit a document supporting a disability claim? It may help to write down a list of your questions or problems. Don't expect to address more than two or three issues in one visit. If you are uncertain about whether you can explain yourself adequately or remember the doctor's response, you might ask a family member or friend to accompany you.
Consider rehearsing a concise description of your symptoms and situation. You might include when the symptoms started, where they are located and what changes in your life might account for them. Also, consider reporting the effects of previous treatment, for example the effectiveness and side effects of a medication.
Take an active role in your appointment. Begin the visit by describing briefly your main concerns. Studies suggest that doctors allow around 20 seconds for a patient to describe her or his concerns before interrupting, so state succinctly your concerns and what you want from the doctor. You might say something like, "I'm here today because my sleep is worse. I'm afraid the drug I've been taking isn't working any more. I hope we can discuss what other medications I might try." You may want to include a reference to your thoughts and feelings about the problem. For example, if sleep is your problem you might say, "I'm concerned because I've been doing better overall and I'm afraid that poor sleep may make all my other symptoms worse and I'll be back where I was two years ago." If you have a written list of concerns, give it to the doctor.
Think of the appointment as a discussion between you and your doctor. Take an active role by asking questions in four different areas:
- Diagnosis & Prognosis: Get clear about what's wrong (diagnosis) and the outlook (prognosis).
- Tests: Ask if any tests are appropriate and what can be learned from them.
- Treatments: Ask about treatment options, both medical and behavioral. Inquire about risks and benefits of each.
- Follow-up: Ask when you should return and what symptoms should require further visits.
To be sure you have understood, repeat back to the doctor the key points he or she has made. For example, you might state that you understand the doctor is recommending you treat your sleep problem by taking two medications, one to help you fall asleep and the other to help you stay asleep. If you don't understand or are not clear, ask the doctor to repeat.
As the visit is ending, ask yourself if you are clear about what you are expected to do next. If you discussed a medication, did you receive a prescription? If so, do you understand when to take it and what kind of side effects to expect? Can you follow-up by phone or would she or he like to see you again? If so, how soon? If you are not clear or are not certain you can remember, write down the doctor's instructions or ask the doctor to do so.
1 Lorig, Kate and others. Living a Healthy Life with Chronic Conditions. Palo Alo, CA: Bull, 1994.