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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 healthcare system have never been less likely to coincide with your own, can be catastrophic.

The problem, of course, is that the healthcare system simply can't afford the traditional doctor-patient relationship anymore. There's no way that HMOs, hospitals, insurance carriers, or federal regulators can allow doctors to continue directing the spending of healthcare dollars as if the only important consideration is the welfare their patients. In thousands of ways doctors are being coerced into giving the needs of each of these other parties a higher priority than the needs of their patients.  The methods being used to apply this coercion are extremely heavy-handed, and are proving to be utterly overwhelming.  No matter how deep their professional integrity, doctors simply cannot continue advocating for their patients' best interests as vigorously as they want to, or as their professional mandate requires them to.  For many doctors, this circumstance causes far more than merely frustration - it causes a sense of utter defeat. The medical profession, many feel, is being totally destroyed. Thus, the systematic destruction of the doctor-patient relationship is bad for everybody. It gravely threatens the professional survival of doctors, and the physical survival of their patients.

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 five general strategies:

Strategy 1 - Be empathetic

Doctors need a little empathy too, and will often respond more favorably to patients who express some. Let her know that you understand the frustrating, externally imposed constraints under which she is laboring. You know how hard it is to be a good doctor these days, and you're thankful she's there for you despite everything. Even if you have to reach a bit to express such sentiments, your doctor will appreciate it-and may become more solicitous toward you and your medical needs.

Strategy 2 - Respect the office rules, even the absurd ones

Try to play by the rules the doctor has established for his practice, even if those rules appear arbitrary and restrictive. Do your best to cooperate with the office staff, as surly as they may be, and minimize interruptions and special requests. If you do have to make a special request, be polite to the office gatekeepers even to the point of physical pain, and try to make sure you let the doctor's staff know how appreciative you are for their assistance (even if you think they've been downright mean to you.)

Strategy 3 - Become engaged in your own good health

Especially in the era of covert rationing, few things frustrate doctors more than patients who, they feel, completely neglect their own health, then expect them to pull out all the stops when they get into medical difficulties.

Look, this isn't fair. Try to look at it not from the standpoint of what's right, but instead from standpoint of the modern doctor. Consider two patients who need special permission for some medical service from a recalcitrant HMO, one an obese smoker who has made no visible effort to take care of himself; the other a diabetic who has carefully tried to follow her difficult diet and drug regimens. For which of these patients is a doctor more likely to risk his viability-determining cost profile? Perhaps neither, of course, but he's more likely to jeopardize his professional security to fight for a patient who is fighting at his side for the same thing.

So look at it this way. Here's yet another reason to take good care of yourself (aside from the much better reason that it might help you avoid the healthcare system in the first place.) Your doctor is likelier to fight for you if you are fully engaged in maintaining your own health.

Strategy 4 - Optimize the time you spend with your doctor

For your own benefit you should try to optimize the 7.5 minutes the doctor is going to spend with you. Plan a visit with your doctor the same way you'd plan an important business meeting. Set specific goals for the visit and write down a list of items you'd like to cover. You might even send your doctor an e-mail (if he's not a Luddite) before the appointment to let him know what your goals are. Bring all pertinent information your doctor might need to know, such as a list of all the medications you're taking. Take notes during the visit, writing down the important points your doctor makes with you. Repeat back to your doctor what you think you heard him say. Consider taking an extra pair of ears with you to the visit. A sympathetic spouse or a good friend can later confirm and reinforce the messages your doctor has given you. Finally, after the visit go over your list once again and make sure your issues were each addressed. If not, you ought to consider e-mailing your doctor within a day or so (while your visit is still fresh in his mind), and ask for clarification of the outstanding issues.

Strategy 5 - Trust but verify

Even the best doctors forget and omit things. So always do your own independent study after you see your doctor, just to make sure the information and explanations you've gotten are proper and complete. When you do find inconsistencies - and you will-it's fine to call your doctor's attention to them on the next visit, but try to do this in a non-confrontational way (remember, you're nurturing a relationship, not playing gotcha). Just say that you've found a somewhat different view on one of the matters you discussed on the last visit, and you'd appreciate a chance to explore the topic further with him. Reasonable doctors will suppress their natural defensiveness at such a thing, and will engage in a genuine conversation on the matter. Most doctors are used to this sort of thing now that we are more than a decade into the Internet era, and don't take such challenges personally anymore. If nothing else, your request will remind him of your sophistication regarding your medical condition - you're listening to what he says, but you're also checking things out for yourself.

With the right doctor, the right nurturing, and the right strategies, it is unlikely your doctor will attempt to withhold potentially important medical information from you. Not only will you be a more informed patient and a better partner with your doctor in managing your healthcare but also you will be immunizing yourself against covert rationing. If every patient did these things, widespread covert rationing would not be possible.

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 healthcare, 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 healthcare they can possibly manage.

Next: Managing your health plan