Despite all the changes that have occurred in the physician-patient relationship over the last ten years --- including the use of electronic health records, patients' use of Dr. Google, direct to consumer prescription ads --- one thing has largely remained unchanged. The overwhelming majority of patients want to please their doctor. After all, you want to be perceived as a "good patient," don't you?
What do I mean by that?
Almost all my patients tell me they take their medicines every day -- they never miss a pill. They all seem to eat salads for lunch, fish for dinner, and drink "socially." And somehow everyone manages to fit in 30 minutes of exercise most days of the week.
And I know this is not true for the majority of patients. It is estimated that nearly half of all patients miss some doses of their daily medicines.
Electronic health records allow me to check when a patient last filled his or her prescription. So when a patient tells me he hasn't missed a dose, I sometimes need to point out that the medicines haven't been refilled in 2 months. The reply is usually, "Hmm...I knew I missed a few. Has it really been that long?"
Despite what people say they usually eat, I always ask them what they had this morning. People tend to be honest. I have heard a "last night's burrito" over 100 times over the years, despite the fact the patients told me they eat healthy. And as for all the exercise patients say they do -- when I ask several earlier this year what they did last month, the answer has often been "it's too cold outside. I'm going to wait until it gets warmer."
I recognize that it is hard to take medicine every day, and change one's diet, and incorporate daily physical activity. And none of us are perfect. And I always tell patients that I am not making any value judgment about the amount of candy they eat or alcohol they drink. But rather, I need to know the correct answer so I can make adjustments in their care.
For instance, many patients with high blood pressure are not well controlled on medicines. At the same time high blood pressure is often asymptomatic and patients don't always see the value in taking a pills or pills every day. But if I assume you are taking the medicine every day, and you tell me you are even though you miss doses, then that impacts how I change your medicine regimen. And that affects your risk of heart attack and stroke. I always let patients know it is normal to miss doses. I just need to know how often it occurs. And knowing that can help me better address their overall health. It might cause me to suggest a simple pillbox, or perhaps a text-messaging program.
If I know you're not really exercising, then I can help explain some simple routines. And often the hardest part is getting started. But again, I can't give tips if you are telling me everything is going fine.
The doctor-patient relationship is a partnership. We're a team in helping you stay healthy or get healthier. So please stop trying to please your doctor by letting us think you are the "perfect" patient. It is compromising your care.