Image by Ken Foreman on Unsplash.
There’s a lot written about doctor-patient communication. You can start with a wide choice of books. There are articles in Medium, such as this one.
Here’s how I respond:
1 – Doctors frequently try to “sell” us solutions, especially drug-based solutions. They rarely tell us the full, honest story.
There is a moving account of a doctor’s thoughts in the book Incidental Findings by Danielle Ofri.Danielle pleads with a severely ill patient who’s been on dialysis. The patient wants to stop dialysis. Danielle knows that modern medicine doesn’t handle chronic disease well. She just wants to keep the woman alive a little longer. In the end the patient is discharged to a nursing home–an outcome she clearly doesn’t want.
I don’t see how Danielle has helped this woman. Her own thoughts show she did not respect the patient’s wishes or values.
2 – Doctors do not give us the absolute risk or the NNT or absolute risk.
If you don’t understand absolute vs. relative risk (and many health professionals do not) see YouTube. Dr. Gilbert Welch explains this well. If you don’t understand NNT (and most health professionals do not) look that up too.
Often a 25-40% relative risk translates to a 1-3% absolute risk (or risk reduction), which is not worth bothering about. With heart disease and cancer, you will find huge amounts of miscommunication about the effects of lowering risk. An article in JAMA showed how misleading the articles on statins can be.
Doctors I’ve seen like to quote guidelines. Guidelines are set by consultation with drug companies. They’re often not based on studies or even logic. Recently the guidelines on mammography were change to include women under 50. Certainly women should get mammograms if they’re justified. But there’s no evidence for this change.
Most doctors don’t know that the guidelines on bone density were heavily influenced–perhaps 100%–by drug companies.
It is hard to trust doctors who give us guidelines and relative risk as reasons for treatment.
3 – We also see an office environment that is not conducive to health.
We wait in crowded, noisy rooms. Some offices play television programs that are truly offensive, such as news programs. Other offices play Food Network shows with gooey unhealthy desserts.
I always refuse blood pressure checks after a wait in a crowded, noisy waiting room, especially a waiting room with a television set. The message is clear: We don’t care about you or your mindset.
There’s not much a doctor can do after that to create a receptive environment, especially during a visit that’s a fraction of the time spent waiting.
Finally, there’s a ton of discussion about doctor-patient relationships. Yet we patients spend very little time with educated doctors. Mostly we see poorly trained but very arrogant medical assistants.
Nurses and Physician Assistants tend to talk down to patients and they are often very rude.
All these people are great sources of misinformation. By the time we see a doctor–IF we see a doctor at all–we’re in no mood to listen respectfully. We just want to get out of there.
