Schoolkids learn early in life that they learn better from some teachers than others. Who was your favorite teacher? Chances are it was someone who explained things in a way that made it easy for you to learn – and at the same time, you felt he or she cared and supported you.
Doctors as teachers
One of the most important aspects of a doctor-patient relationship is helping the patient understand what the doctor is looking for, the methods used, what is discovered, and what can be done about it.
In the “old school” style of medicine, it was not uncommon for doctor and patient alike to assume that the doctor was a knowledgeable authority and the patient would go along with whatever the doctor said. There was little thought of questioning or probing, as that might be seen as impertinent.
In today’s “new world”, medical students learn about patient-centered care. Its principles were developed based on interviews with patients. One principle is information and education, which arose from patients’ worries that they were not being completely informed about their condition or prognosis. Therefore, doctors are encouraged to educate their patients about their condition status and progress, what will be done to provide care, and how the patient can responsibly promote health in their own life. Not only does understanding these matters help patients feel less anxious and have a sense of control, but as it turns out, they also feel like the doctor cares about and supports them.
Some doctors are better at this than others
It’s my experience that patients want to learn about what’s going on in their bodies. However, there are learning obstacles. According to one study, “Patients value receiving educational information during office visits, but physicians often lack the time or training to satisfy this need.”[i] In addition, “There are many barriers to good communication in the doctor-patient relationship, including patients’ anxiety and fear, doctors’ burden of work, fear of litigation, fear of physical or verbal abuse, and unrealistic patient expectations.”[ii]
Training is improving, but even the best communication skills tend to fade as the rigors of medical school continue. Not only do doctors in training lose their focus on holistic care, but also “the emotional and physical brutality of medical training, particularly during internship and residency, suppresses empathy, substitutes techniques and procedures for talk, and may even result in derision of patients.”[iii] By the time many doctors finish training and are brought into a busy practice, the economic realities of managing healthcare costs often drive practice pressures to see a certain number of patients per block of time, and perform a certain number of in-office procedures. It can be overwhelming, and even MD’s with the highest ideals and warmest personalities can find themselves deprived of the time to adequately serve the patient’s need for dialogue.
In defense of my colleagues whose daily realities leave them strapped for time or shortchanging patients as the schedule starts backing up, I can only say I understand. If patients are frustrated, so are the docs.
The flip side – what can patients do?
While I and my colleagues value the principle of educating and informing our patients, we do our best to make time for, and provide, dialogue. We try to touch base with patients in the waiting room if we’re running overtime, and greatly appreciate their understanding if a procedure is taking longer than anticipated.
While I can’t speak for other doctors, one of the ways that patients facilitate the dialogue process is when they come in with a list of questions and concerns. For instance, I might be showing a patient his MRI and explaining what that dark area is, and he’s wondering what the Gleason grade means now that he’s seen his biopsy results.
One way of looking at this is the example of the standard TRUS biopsy. Even when 12 cores are taken, the process is random and blind, often missing the most important cancer. Instead, a real-time MRI guided targeted biopsy is far more accurate because it reveals what I have to aim at. Similarly, I may enter a consultation prepared to tell the patient about his disease, but if he doesn’t reveal what’s uppermost on his mind, I may inadvertently fall wide of the mark.
In short, I truly believe that we doctors want to teach our patients what’s most important about their bodies and their situations. Patients can help us be better teachers by asking about what’s on their minds.
[i] Terry PE, Healey ML. The physician’s role in educating patients. A comparison of mailed versus physician-delivered patient education. J Fam Pract. 2000 Apr;49(4):314-8.
[ii] Ha, JF, Anat DS, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010 Spring; 10(1): 38–43.