Patients Are Powerful

Archive for February, 2010

Talking to a doctor (when you’re a patient in an exam room) isn’t easy. I’m not talking about those fleeting moments when you suspect the doctor of having “God-complex” issues that make you feel as if you won’t be heard unless you genuflect or get down on both knees. No, what I’m referring to is when you’re standing barefoot or sitting bare-bottomed wearing a paper gown, with florescent lights beaming down on you making you look even less healthy than you already feel. Under these awkward and embarrassing circumstances, with the doctor fully dressed and sporting the all-wise, highly-achieved white coat, while you’re lacking even the basic outer accouterments that might give a modicum of self-confidence, it’s pretty hard for you to get your thoughts in order and feel your patient power. Instead, when it comes to your asking questions about your health, medical condition, and treatment, you feel uncomfortable, anxious, and ineffective. The “power gap” is almost palpable!

It is uplifting to take note that, in the last decade, some medical schools have started trying to bridge this gap by teaching their med students “clinical communication skills.” Third-year and fourth-year students are actually being required to role play, i.e., face-to-face encounters with actors playing patients of varying ages with a variety of dispositions and diseases. The students are then tested to see how well they interview “patients,” conduct physical examinations, and convey exam findings to the patients. Obviously, their ability to be empathetic is a big plus.

The good news is that this type of training doesn’t stop after graduation. In fact, in March 2005, the Communication Skills Laboratory at Memorial Sloan-Kettering Cancer Center began offering a series of three-hour interactive workshops intended to give hospital oncology residents practice in “Breaking Bad News,” “Discussing Prognosis” and “Responding to Patient Anger,” among other touchy health-related topics.

Still, with all the emphasis on a doctor’s communication with patients, the patient advocacy side of the problem has largely been neglected. For instance, where are the guidelines for patients, such as “how to” or “when to” raise important questions that will help to calm the psyche without alienating the very person who may end up standing over them with a scalpel in his or her hand?

Unfortunately, the number of appointments (confrontations?) that require a negotiation between the doctor and the patient seemed to be on the rise, while the amount of time spent with a patient during a medical visit seems to be on the decline. How does a patient get the answers they need from their doctor, or how do they respectfully disagree?

A patient advocate is invaluable when it comes to helping patients prioritize the questions that are most pressing. Studies have shown that often the most important symptom or worry that a patient may have, such as a suspicious mole or lump, or even the feeling that life isn’t worth living, is often not on the top of a patient’s list, and such questions are frequently blurted out at the very end of an appointment because the patient was either afraid to ask the question or didn’t know how to prioritize it in the framework of a typical medical exam. In these instances, patients who have a patient advocate by their side can feel more confidant and be more assertive when requesting a follow-up meeting.

So, in this current healthcare climate, even when doctors are taught to listen attentively to patients, they are also well-aware that with low insurance reimbursements such attention comes time-constraints attached. The more a prepared a patient can be prior to a scheduled appointment with their doctor, with a list of prioritized questions in hand, the more patient power they will have.

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