Just recently, a study of more than 1,000 conversations between
doctors and patients published in the Journal of the American
Medical Association showed that in nine out of 10 cases patients
didn't get good explanations of proposed treatments or tests.
And
while it's easy to feel intimidated by all the high-tech hustle
and bustle, research shows that active, assertive patients with
high blood pressure, diabetes, ulcers or arthritis are more likely
to follow a doctor's advice and get better when they
fully understand their treatment -- and have a voice in planning
it.
But raising that voice isn't easy.
"Older patients especially feel very vulnerable,"
says Timothy McCall, M.D., internist and author of "Examining
Your Doctor: A
Patient's Guide to Avoiding Harmful Medical Care". And doctors
\send all sorts of signals that they are pressed for time. (The
average length of an appointment is just 15 minutes!)
Choosing to end a relationship with a doctor can be difficult.
"Many patients are hesitant to leave their doctors because
they
have no guarantee they'll find a better one," McCall says.But
there are warning signs that can alert you to an uncaring or negligent
physician. Does he or she:
-- Answer questions or ask if you have any?
Any doctor who doesn't adequately explain procedures or medical terms, or seems to be withholding information, can cause a patient to be afraid, confused or unable to follow a course of treatment.
-- Fail to take medical history or give physicals?
Some conditions can't be diagnosed on the spot, or attributed to one specific cause. But a doctor who performs an incomplete examination, or dismisses your problem, may leave you with a condition that may turn dangerous without early treatment.
-- Neglect to inform you of side effects of medications?
Many men with high blood pressure, for example, don't take their anti-hypertension drugs after hearing that impotence is a possible side effect. But other drugs may be substituted.
-- Discourage getting a second opinion?
A doctor who dissuades you from getting another opinion probably perceives it as a test of his or her abilities. But a second opinion can support an initial diagnosis -- or provide another treatment option not considered earlier.
Any of these situations is enough to make you look elsewhere. But you should know how to check on another doctor's record and qualifications as well. Much of the negligence doesn't violate licensing requirements -- and doctors are rarely accused publicity of misdeeds or malpractice.
If your doctor scored poorly on these important factors in
a doctor patient relationship, it may be time to consider parting
company.
But before you do, ask yourself if you've been a responsible patient.
Often problems arise when patients don't reveal their full medica history -- or forget to alert their doctor about other drugs or supplements they may be taking. A doctor-patient relationship is \a two-way street:
-- Be prepared. The more explicit you are about your pain and
symptoms, the more likely you are to be heard. Jot down any specific
questions you have, and the names and dosages of all medications.
If that's too hard, bring them with you.
-- Ask questions. Don't be afraid to ask the doctor to explain
something you don't understand. If you're prescribed a drug, make
sure
you know what it's for, how to take it, and what to do if side
effects appear.
-- Do your homework. Learn as much as you can about your medical
problem in the library or on the Internet. If you come across
an article your doctor may not have seen, mail or fax it to
the office before your next appointment.
"A well-informed patient can help a good doctor practice better," McCall says. "Medicine has become so complex, there's so much information and so little time, that most of us simply can't keep up with it all."
If you're sure the problem isn't on your side, confront your
doctor with your grievances. Or if it's easier, write them down
in a letter.
Simply expressing your dissatisfaction may open the communication
lines between you and your doctor.
"Sometimes doctors aren't aware they are in the midst
of a deteriorating relationship until a patient tries to leave,"
says Sherrie
Kaplan, a social scientist at Tufts University Medical School
in Boston. Being forthright about what you want from the relationship
can be an eye-opener.
Good medical care is more than diagnosis and treatment. It's
also an attitude on the part of the doctor that sparks a sense
of trust. Any
doctor who is impersonal, condescending or inconsiderate violates
this trust.
What if being active and assertive isn't your style? You can make a clean break by simply going to another doctor. Keep in mind, however, that your most important concern should be continuity of care. Unless the situation is intolerable, stay with your current doctor until you have found another physician you like.
Generally, medical records will be turned over to your new doctor once you have signed a release approving the transfer. They cannot be withheld for any reason, even if you have not yet paid your last bill.
(c) 2000, Norman Brown. Distributed by the Los Angeles Times Syndicate