You have had that nagging back pain for several years now and mentioned it to your primary care physician. In the past over the counter medications seemed to work, but lately it interferes with your golf game and ability to hike on vacation. You schedule an appointment to see your physician, hoping to get an MRI scan of your back and maybe a course of physical therapy to set you back on track. However, after what seems like an all too brief encounter, you are told you aren't getting any younger, ought to lose some weight and maybe you aren't taking the medications as suggested.
You are upset, feel "blown off" and no closer to a solution for your problem. What went wrong? You knew what you wanted going in to the visit, why did you come out empty handed?
Sound familiar? It should, as the Centers for Disease Control and Prevention report 902 million office visits each year, or about three visits per year for every person in the United States.
The Internet is loaded with advice about always taking a list of all of your medicines; recordings of all your home blood pressure readings and a list of questions. All good advice, but I think there is something much more fundamental that determines success or failure for your doctor visit.
Perceptions and Expectations
Herb Cohen, negotiator and author of "You can Negotiate Anything," points out that it is always the "How" -- or emotional content of an encounter -- that drives the "What," or facts of the event. Have you ever had an encounter at wok that raised your blood pressure and had steam pouring from your ears? You couldn't wait to get home and tell someone about your awful day. You drive on the freeway getting even more agitated as you re-live the event -- blow by blow. At dinner you pour out the injustice of the events only to have your partner or family give you a pathetic stare and remark, "That doesn't sound so bad." It was the "how" of the encounter. In other words, you had to be there. In brief, it was your perception of the event and what you "brought to the party," that led to your emotional response. And, so it is with physician-patient encounters.
The physician has an expectation of how they "should" be treated by the patient/family and how the patient "should" behave. The patient has similar preconceived beliefs about how the visit "should" go. "Shoulds" are dangerous! Albert Ellis, the founder of Rational Emotive Therapy remarked, "don't should upon yourself."
Equally dangerous are unrealistic or unmet expectations that lead to stress, frustration and anger. The perfect patient experience is when the patient's expectations are recognized and are met by their physician.
Physician Patient Expectation Disparity ( PPED)
I like an expression coined in 1994 by the pediatrician, Dr. R. Sagall. He refers to the mismatch in physician/patient expectations. The patient enters the doctor's office with an expectation of what will happen and the eventual outcome. As a patient, when you go the doctor, do you expect to:
- Receive antibiotics for what your doctor may believe is a common cold?
- Receive testing for your symptoms as opposed to watchful waiting?
- Obtain total relief of your pain?
- See the same physician each time?
- Walk after you have had a stroke?
The list can be never ending and tailored to whatever problem you have on that particular visit. How to do we bridge this gap and teach patients to clearly express their expectations and physician's to "ask and listen?"
Physicians would love it if every patient could give a brief, clear history that gave them just the information necessary to make the diagnosis and prescribe the appropriate treatment. It might help if we asked every patient, "What do you expect from today's visit," or "At the end of your father's rehabilitation stay what do you hope he will be able to do for himself?" We would be able to quickly determine not only the nature of the expectation but whether it is realistic. As a patient or family member have you ever left an office visit or physician conference and felt:
- I should have...
- I didn't get what I needed...
- I am not respected...
- No one cares....
- Other patients are more important....
They all arise from the mismatch of expectations and the reality of what happens. So, what can you do to avoid this trap?
The Keys To Meeting Expectations
1. Ask yourself and tell your physician what you expect during that visit or hospitalization. This is not just a list of complaints, but what you would hope will be the final outcome.
2. Ask yourself, "Are these expectations realistic given the circumstances of the event? If I have symptoms of a typical cold , is it reasonable to expect antibiotics that won't really help?
3. If you are angry with the doctor or their staff, ask yourself "why?" If you are mad that you had to wait, ask whether you were "worked in" and if a wait is reasonable? Is there a patient with an unexpected serious problem who requires extra care- next time it could be you?
4. Focus on solutions not excuses. Frequently the patient or doctor are explaining why they couldn't do something rather than how to solve the problem.
5. Take someone with you if it is a complicated problem. They can take notes and be an extra set of ears to remember what was said.
6. Get copies of your lab work and MRI/CT scan reports. You can refer to them later to remember what was covered.
7. Accept responsibility for the problem. Are you expecting the physician to solve a problem that requires at least 50 percent effort on your part?
8. Recognize you and your doctor can only control the controllable and you cannot eliminate uncertainty from your life.
Here's to the expectation that your next visit will be a better one. Do you have any tips that you use to make the most of your doctor visits?