Good communication between doctors and patients is critically important: unless our doctors understand what ails us, it will be very hard for them to help us heal. And without being clear on our end about what we need do to regain our health—which pills to take when, for example, and for how long—the likelihood that the prescribed treatments will fail increases substantially. This can lead to extra and often unnecessary testing and procedures, greater expense, poorer health outcomes, and added misery and suffering.
Another problem arising from poor communication with our doctors it that it deprives us of what British physician Michael Balint referred to more than half a century ago as “the drug ‘doctor.’” Balint defined this as the powerful therapeutic effect that results from the very interaction between doctor and patient which, when harnessed appropriately, can yield profound health benefits in and of itself.
One way in which the drug ‘doctor’ is given is through the simple reassurance that what concerns the patient is not in fact worrisome, or cause for alarm. For example: the chest pain that brings a middle-age man, certain he is having a heart attack, to the emergency room and which proves, after careful assessment, to be no more than a pulled muscle. Once he is given the diagnosis and understands that the treatment will involve no more than warm compresses and ibuprofen—and not, as he feared, coronary artery bypass surgery—the changes in the patient’s anxiety level, blood pressure, and even physical discomfort can be dramatic. This is no different, really, than the effect that a mother’s kiss has on a child who has just skinned her knee on the playground. “You’re fine, really,” it tells her, and prompts her to get up and run back to her game of tag.
The drug ‘doctor’ can only be made available if the patient and his physician are able to communicate with each other well enough to establish a relationship based upon trust, mutual respect, compassion, understanding, and agreement upon common goals for the patient. This is contingent upon there being adequate time to allow for this at visits. Unfortunately, current trends within the business and practice of medicine have converged to create significant obstacles to the communication necessary for good care. Many patients, especially the elderly, are more medically-complex than in previous years, able now to live significantly longer with the same diseases than they might have might have twenty, or even ten, years ago. This leaves them with longer problem lists that stretch their doctor’s already limited time beyond what is reasonable. A recent study of primary care physician visits, for example, found that the doctors addressed an average of six different medical problems with each patient during the course of the visits. The patient’s main problem received five minutes of attention from the physician; the other five, about a minute each. If it seems improbable that anyone could properly understand, evaluate, and resolve a medical issue in one minute (take your pick: heartburn, shortness of breath with exertion, back pain, difficulty urinating), that’s putting it mildly. Actually, it’s impossible.
As if that weren’t bad enough, falling reimbursement rates mean that doctors are under pressure to see even more patients in less time so that they can maintain their income. And the meddling by governmental agencies and insurance companies in how doctors and patients interact with each other—in the name of ‘efficiency’ and purportedly better-quality care—divert precious physician time away from talking with their patients in favor of data entry and the completion of computerized check lists.
A recent study by the Commonwealth Fund found the American health-care system to be last in most measures of performance when compared with those of 10 other developed countries, even though ours is by far and away the most expensive. Without real push-back from both patients and doctors against the trends actively undermining the doctor-patient relationship, the quality of our care will continue to decline, to the detriment of all involved.
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