I think this article from today’s Health Section in the New York Times makes evident just how important a positive doctor-patient relationship is.
If a patient (and/or their family) feels marginally comfortable with their doctor, such that only certain questions are permissible, it makes us wonder how many accidents/errors/or conflicts could have been avoided.
One method of potentially improving patients’ ease is through thorough explanations by the doctor and/or medical team. By providing a comfortable, informed environment, health care providers can foster a setting in which conversation is easy.
By telling the patient things to expect, details of/reasons behind the process, and their experience with the procedure, patients are comforted, and most importantly, informed. By having a general understanding of the upcoming events or expectations, patients may be better able to formulate questions for their doctor.
By laying out the expected proceedings, things to watch out for, as well as general information, a better experience can be attained on both sides of the scalpel, regardless of science literacy levels or other means of access to medical information.
Thursday, April 3, 2008
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The first thing I thought of (when I read the headline of this article) was the episode of Seinfeld when Jerry is dating a girl and they go to her father’s restaurant. Jerry then observes the father use the restroom, leave without washing his hands, and prepare Jerry’s food. This also reminded me of a Gary Larson cartoon in which a man emerges from the bathroom, only to have the “Did not wash hands!’ alarm go off – alerting the entire restaurant.
This article highlights an important issue in the medical practice. I for one, have great respect for doctors. However, I agree with the premise of the article, which asserts that asking your doctor’s questions such as “have you done this operation before,” or “have you washed you hands,” are important steps in receiving medical care. One of the first lessons I learned as a child was to frequently wash my hands (prior to eating, after using the bathroom, etc.). I would hope that a person with 7-8 years of advanced medical schooling would wash their hands.
This article made me think back to the US Healthcare Systems course that I took two years ago. In this class we learned that the average time a doctor spends with each patient that he/she sees in his/her office is somewhere between 5-10 minutes. With this little amount of time it is no wonder that patients don't ask their doctors questions.
I'm sure that I am not the only person who has felt like a nuisance to my doctor from time to time. I don't think that not asking questions is simply because patients don't want to offend their doctors. I think that people honestly feel like they don't want to be an imposition, especially if they are visiting their doctor for something like a routine check up.
I recently learned about someone who appeared to be in great health and only discovered that he had cancer after getting in a car accident, resulting in a more complete physical exam. I couldn't help but think back to those 5-10 minute doctor visits - are doctors really do their jobs?
I once went in for an eye exam with a very reputable doctor. My eye exam lasted maybe 10 minutes tops. She was very professional and efficient in her work, but I felt the anxiety in her rushing through the exam. I had many questions I wanted to ask her, but before I had a chance to ask one, she handed me the prescription and was booking it to her next patient. I realized that she had written the wrong prescription and ended up having to wait until I could catch her in between patients to get her to write me another prescription and ask her my questions.
Although my eye doctor was great at her work, I personally had no desire to return to her next time I needed a check up. I think it is very important for doctor-patient relationships to feel like a partnership. Patients often feel vulnerable in the doctors office, and rushing through an eye exam to get the wrong prescription does not help the comfort level in the doctor's office much.
This article highlights one of the foremost constraints in the healthcare system particularly when it comes to the issue of Doctor-Patient Relationship. In the modern age the title of a physician is observed as being very reputable thus sometimes we as patients forget that Doctors are people too and can make mistakes. Therefore in those instances its our duty to alert them, the same way they alert us about various risks, etc. I think if we as patients really hoped for a more collaborative treatment plan where a doctor is not a power figure but a partner helping you get better, then its crucial that we as patients be able to ask the most challenging of questions. Questions such as "Did you wash your hands?" or "Have you done this procedure before?" should be implemented into the patient's bill of rights. Or if asking the most challenging questions was so difficult then it would greatly help to have each doctor atleast fill out a simple form which is handed to patients about his/her experience of the procedure and other questions such as involving washing hands etc. It that way the patients will get the most challenging questions answered and the doctors will have one more precaution measure to make a treatment/surgery more successful.
I found it quite interesting that patients were more willing to ask nurses challenging questions, rather than the doctor who was going to actual be performing the surgery or other procedures on them. I couldn't help but ask: why do patients feel more comfortable talking to nurses as opposed to doctors? Aren't the doctor's suppose to be the "experts"? Aren't we always out to get an "experts" opinion? and if so, why not ask the doctor? I think that the relationship between a doctor and a patient is a critical part of medical care, and more research needs to be done to explore the reasons why patients are (perhaps) afraid to address certain questions they may have, for fear of being thought of as "ignorant", or for fear of interrupting the lives of already busy professionals. However, it is important to keep in mind that it is part of a doctor's job to answer such questions, and to make their patients feel comfortable.
Like other people have said, I think it is important that doctors be open
to these types of questions in order to provide the patient with a
comfortable environment and help him/her relax. If I saw that a doctor did
not stop to wash his hands, I would wonder what other basic procedures/
cleanliness steps they skip. I also have felt like a bother to the doctor
and that they don't really have time to answer questions or go beyond a
specific time limit. I understand they are busy but I think it is
important that they realize the patient watches what they do, and that
everything a doctor does should help foster a health partnership between
doctor and patient.
I must admit I've been pretty luck to have doctors (physician, eye doctor, specialists, orthodontist) who really put in the time to establish a relationship with me, the patient. I'm a very curious kind of person, and since I have been seeing the same medical caregivers for a long time, I feel extremely comfortable talking to them about my medical needs as well as other things like what I plan on doing with my life. And I have no fears in asking questions like even "Did you wash your hands." I'm sure I'll experience these sorts of communication issues when the time comes to move much farther from home and find new doctors etc.
I spent my summer in Korea and now realize how unique the doctor-patient relationship in America is. When I went to the Korean hospital’s emergency room because I had strep throat, there was no communication at all. The physician examined me and quickly wrote me a prescription and asked me to put out my arm so that he could give me a shot. Of course, I was very hesitant. I asked him in Korean "Do I have strep throat?" To my surprise, he had a very puzzled look on his face as he responded with "how do you know about streptococcus?" He was shocked that I was informed about what strep throat was and even that I had gotten my prescription correct. After I asked this question, he became very intrigued about my science education background and how the medical system worked in the United States. Physicians in other countries (such as Korea) are not expected to communicate with their patients nearly as much as physicians are in the United States. Ironically, by not communicated to the same degree, these physicians also demand much more compliancy from patients. As I looked around the emergency room in Korea, I saw patients asking minimal questions. I agree with the article that doctor-patient communication is critical. For instance, certain medical measures and procedures will be greatly improved if the patient communicates their family medical history. In my opinion, it is critical that patients do not create a division between themselves and their doctors. We should educate ourselves on medical terminology and scientific information in order to have a meaningful dialogue with our doctors that will ultimately benefit OUR health.
I started to think about my own respect out of fear for the uncertainties that hospital visits provide. RN’s in my family paint a similar picture of patients being less hesitant to ask them questions as opposed to their attending physicians. The article also paints a picture about gender and certain forms of communication in finding that women are more likely to question than men.
I agree with Tashi in saying that in efforts to protect the doctor patient relationship we forget that they too are humans and while we may not have their expertise, we are entrusting our health to doctors and as such should ask challenging questions. The survey idea sounds like a practical way of getting patients to feel more involved in their care and to be comfortable to express themselves.
I also found this article very interesting. In light of the fact that when someone is sick enough that they need medical attention at a hospital, it is expected that he/she will receive the necessary attention that we all come to expect from medical professionals. I have unfortunately frequented hospitals in the past few years from traumatic sports injuries and I will be the first to say that hospitals are not a fun place. However, each time I entered a hospital, I was never concerned that the medical staff was doing something wrong, not telling me the truth, etc. I always felt that I was receiving the best care possible and this article made me question the validity of that thought. The simple act of washing one's hands; maybe it's not so simple after all...?
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