Managing your doctor - Nurturing the doctor-patient relationship

Why the doctor-patient relationship needs nurturing

If you've spent any time with our Grand Unification Theory, you know that the traditional doctor-patient relationship is in deep trouble. And you know there's a good reason it's in trouble.

The traditional doctor-patient relationship requires physicians to always advocate for the best interests of their individual patients. When you are sick, the traditional doctor-patient relationship guarantees there is at least one knowledgeable professional who is looking out, above all, for your interests - not the interests of the insurance plan you're in, or of your demographic group, or even of society at large, but the interests of the individual, you. The loss of such an advocate, especially at a time when the interests of all the other parties within the health care system have never been less likely to coincide with your own, can be catastrophic.

The effective patient's strategy

In becoming an effective patient, you've got to take the weakened state of the doctor-patient relationship into account.  Simply assuming that your doctor is always going to be acting in your best interests - no matter how good a doctor he is, or how ethical - is a big mistake.

The effective patient understands this, but she understands something else, too. She understands that her doctor (if she's chosen her doctor wisely) deeply wants to honor the traditional doctor-patient relationship, since honoring that relationship is his first duty as a professional.  She understands that, despite all the coercive pressure to the contrary, her doctor will occasionally go up against an HMO for the benefit of a patient. He needs to do this as a matter of professional pride - just to be able to live with himself.   (The HMOs understand this, too.  Letting the doctors win one now and then - only, of course, after putting up a stiff resistance - costs them some money, but in the long run keeps the doctors mollified.  It keeps the doctors working, and it keeps them quiet.  It's just one of the costs of doing business.)  The effective patient also understands that, as much as he may want to, her doctor cannot go to the wall for every patient, or for every issue that comes up for a given patient. The process would be too grindingly difficult, and fatal to his career. She knows that her doctor must choose his battles carefully.

The effective patient understands all this, and nurtures her relationship with her doctor accordingly. She tailors the relationship in such a way that, when the chips are down, she is likely to be one of those her doctor will go to the wall for.  

To be such an effective patient, consider following these three general strategies:

Strategy 1 - Be empathetic.  Show that you understand the constraints under which your doctor is laboring, and adjust your expectations accordingly. Don't be too demanding, especially regarding the small stuff.  Show that you respect your doctor's skills, and that having her skills working for you is worth a few minor inconveniences. After all, you make clear, you know how hard it is to be a good doctor these days, and you're thankful she's there for you despite everything. 

Strategy 2 - Align your interests with those of your doctor.  Remember: you and your doctor are in this together. He feels your pain, and you feel his. You both want the same things.  You both want the patient (you) to get good health care; and you both want the doctor's practice - and professional integrity - to thrive. So while you fully expect to get the care you need from your doctor, you will help him to deliver that care as efficiently and as cheaply as possible.

You will not bother him needlessly, or thoughtlessly. You will make the most efficient use of your time with him. (See Managing your own health.) You will learn how his office operates, and cooperate with his office staff in minimizing interruptions and special requests. (For instance, inquire as to the best time to call the office with questions, or to speak with the doctor.)  The main idea is: you are interested in making the doctor's job as easy for him as possible, while still having your own vital needs served. 

Strategy 3 - Become engaged in your own good health.  Nothing makes doctors crazier than patients who completely neglect their own health, then expect their doctors to pull out all the stops for them when they get into medical difficulties.  The fact is, your doctor simply cannot afford to vigorously advocate for every problem for every patient.  This being the case, which patient is your doctor more likely to fight for when they get sick - the obese smoker who has made no visible effort to take care of himself, or the diabetic who has carefully tried to follow her difficult diet and drug regimens?  

Maybe it isn't fair, but it's nonetheless true. If a doctor is considering stepping out of line and jeopardizing his own security to fight for his patient's best outcome, you can be sure he's more likely to reserve that action for a patient who's fighting right at his side for the very same thing. 

You greatly increase the likelihood that your doctor will go to the wall for you if you are fully engaged in maintaining your own good health.  You need to stop smoking, lose weight, exercise, take an interest in disease prevention, and during your visits to your doctor, demonstrate how involved you are with your own health care.  Make yourself into the kind of patient that doctors find it a pleasure to see. (See Managing your own health.) 

Summary

By understanding how and why the doctor-patient relationship is under fierce attack, you can "manage" your own doctor-patient relationship to make yourself a more effective patient. 

Any doctor worth her salt will respond favorably to patients who seem to understand the duress she faces each day in the practice of medicine, who try to help her keep her head above water while she provides health care, and who take an active role in maintaining their own health.  Patients like that are worth their weight in gold, and doctors try hard to provide them with the best health care they can possibly manage.

Next: Managing your health plan

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