One of the greatest benefits of being a physician is that since I can handle most of my routine health care needs myself I rarely have to be a patient in another doctor's office. However, on those few occasions when I have consulted another doctor for advice I have had rather disappointing experiences.
During my years in medical practice I have heard a lot of complaints from patients about other doctors and sadly I have found that most of those complaints are true. I know that doctors are heavily educated in the sciences and receive little training in communication, but it seems shocking to me that in the 21st-century doctors have not yet recognized the importance of the doctor-patient relationship.
As part of the movement to reform health care, streamline our system and improve cost-effectiveness I believe that physician behavior must be overhauled as well. Here are five common tendencies of doctors that need to change:
1. They don't listen.
This is the most common complaint I hear from patients about other doctors and it was my experience, as well, when I was briefly a patient. Studies have shown that during the average office visit the patient is allowed to speak for no more than 18 seconds before the physician interrupts! From that point on, the physician controls the conversation by asking directed questions and limiting the time available to the patient for a response.
One problem with this behavior is that the physician may miss critical information that the patient was hoping to convey, leading to misdiagnosis and inappropriate treatment at times. Not to mention the fact that the patient feels frustrated and uncared for when his or her story has not been heard.
2. They don't establish a relationship with the patient.
A study reported in JAMA shows that patients are far less likely to sue a doctor who makes a mistake in their care if they feel they have a relationship with the doctor.
Yet many doctors have difficulty connecting with patients and do not communicate well with them. According to research reported in the NEJM, this leads to poor patient compliance with treatment, decreased patient satisfaction and poorer outcomes. (1) Empathy and communication are vital to establishing productive doctor-patient relationships.
3. They don't treat the patient as a whole person.
Many Western medical doctors treat only the patient's physical symptoms and ignore the influence of the mind, spirit and emotions on health. They miss the fact that disturbances in the psyche and soul can manifest as physical symptoms even when there is no physical disease present.
Trying to diagnose a condition while looking at only the physical body is like putting together a jigsaw puzzle when you are missing 75 percent of the pieces -- you will never have an accurate perception of the whole picture.
4. They don't discuss end-of-life issues in a timely manner.
A new report from the Institute of Medicine has shown that discussions between patients and their doctors about options for care at the end-of-life are not occurring until late in the course of the illness, when time is often too short to make well-thought-out decisions.
Doctors should be initiating this discussion with all older patients, as well as those who are terminally ill, in order to facilitate the best possible care at the end-of-life that meets the patients' needs. This will help avoid unnecessary or futile care during the last weeks of life.
5. They choose fear over wisdom.
According to an online survey by Jackson Healthcare, nine out of 10 U.S. physicians report practicing defensive medicine, which costs an estimated $650 to 850 billion annually.
When it comes time to make treatment decisions on behalf of patients, instead of relying on years of training and on the wisdom garnered from treating thousands and thousands of patients, doctors allow their fear of a lawsuit to outweigh their better judgment. They order tests they know are unnecessary in order to reassure a nervous patient rather than trusting their own knowledge and intuition. As shown above in #2, doctors who form a genuine connection with patients are much less likely to be sued, even when they make a mistake.
Being a physician is not an easy job and I certainly understand the stresses and demands that all of my colleagues in this profession experience. However, there is no excuse for providing thoughtless, compassionless care to patients, which decreases cost-effectiveness, efficacy, and patient and physician satisfaction. I know we doctors can do a better job and it is time that we reform our own behavior. We can change health care for the better if we are willing to change ourselves first.
1. Gaps in doctor-patient communication: Patients' response to medical advice. Francis, Vida; Korsch, Barbara M.; Morris, Marie J. The New England Journal of Medicine, Vol 280(10), 1969, 535-540.
About the Author: Dr. Karen Wyatt is a hospice and family physician and the author of the award-winning book "What Really Matters: 7 Lessons for Living from the Stories of the Dying." She is a frequent keynote speaker and radio show guest whose profound teachings have helped many find their way through the difficult times of life. Learn more about her work at www.karenwyattmd.com.