Does the thought of talking to your loved one’s doctor make your heart race and your palms sweat?
A study published in the journal “Health Affairs” and conducted by researchers at the Palo Alto Medical Foundation Research Institute in California found that a good portion of people do not consider their relationships with their physicians to be collaborative. Despite efforts to encourage shared decision-making, patients still feel that they are subordinates and doctors are their superiors.
The study consisted of a series of focus groups in the San Francisco Bay Area and revealed that, even though most patients said they desired an honest dialogue with their doctor, many didn’t feel comfortable actually having that conversation once they got into the exam room. When asked why they were hesitant to talk openly with their doctor, some participants said they felt they needed to conform to the traditional role of the compliant patient, while others felt that their physician was too “authoritarian” to be accessible. Some participants even expressed a fear of being labeled as a “difficult” patient and receiving substandard care in retaliation.
While this study was conducted on the patients themselves, the findings coincide with two common concerns that caregivers have: How will my interactions with the doctor be perceived, and how could this affect the care my loved one receives?
These findings are unsurprising to Dr. Kevin B. Jones, surgeon and researcher at the Huntsman Cancer Institute and author of “What Doctors Cannot Tell You: Clarity, Confidence and Uncertainty in Medicine,” Although he was not involved in the study, Jones agrees that most patients don’t want to annoy a physician and get abandoned. “They are afraid to ask questions,” he says.
When it comes to communicating with doctors, Jones says patients and their advocates should be afraid of not speaking with them. “They should be more concerned about the things they are not learning and the things that are not being explained to them,” he warns.
For caregivers, having an honest dialogue with a senior’s doctor can help you gain valuable insight into your loved one’s condition, thereby enabling you to provide better care for them. You can learn what challenges a given disease or treatment plan may present and what signs and symptoms to watch out for.
The Confidence Conundrum
Jones feels that the traditional views of physicians as all knowing may be doing more harm than good, especially when it comes to communicating with baby boomers and those over the age of 60. “Having a sense of respect for doctors isn’t a bad thing, but it can be a problem if it inhibits conversation,” he admits.
According to the San Francisco study, even financial security and higher education don’t seem to help patients feel less apprehensive or act less deferential when conversing with their doctors. Every person participating in the experiment was 40 years old or older, a good portion had completed graduate school, and 40 percent reported at least a six-figure annual salary. Yet, many still said they felt as though they needed to comply with the doctor’s recommendations, whether they agreed with it or not.
However, having confidence in a doctor’s guidance is very different from simply deferring to what they think is best. If you don’t believe a doctor is knowledgeable about your loved one’s health, how likely is it that either of you will listen closely to that physician’s suggested course of treatment or follow through with it?
Jones’ solution to this dilemma lies in re-thinking the traditional doctor-patient paradigm. A physician is simply someone who has more experience with a certain category of knowledge than the average person does—much like how a teacher knows more about the subjects they teach than their students do. Would you hesitate to ask a teacher to help you understand a difficult concept?
Medicine Can’t Cure Everything
Jones adds that Americans’ confidence in the medical field is another factor that complicates doctor-patient relationships. People often have misdirected (and sometimes blind) faith in medicine’s ability to cure what ails those they love.
In truth, not every medical problem has a solution. This is something that doctors know, but may be difficult for their patients and caregivers to recognize or accept. “The challenge is that what medicine knows, it does not know with much certainty,” Jones says.
For doctors, it can be tricky to make patients feel comfortable and confident and also avoid unintentionally giving them false hope that a diagnosis is definitive or that a particular method of treatment is guaranteed to be effective.
According to Jones, when doctors and patients do not engage in open communication, that’s when serious mistakes get made. “We [doctors] are human. Our knowledge is about human biology, which is widely variable,” he acknowledges. “If we’re going to be clear and honest about that, it’s going to take a dialogue.”
Tips for Two-Way Communication with Doctors
When it comes to communicating with any health care professional, it’s not about whether or not you should ask a question. You should. Learning how to communicate questions and concerns is crucial for getting a physician to collaborate with the rest of a loved one’s care team. Use the following tips to ensure everyone is on the same page.
- Keep it friendly and open-ended. Jones suggests making your queries open-ended and non-adversarial. “It’s about asking in a way that a good student might ask a teacher. You’re basically saying to the doctor, ‘Help me understand what you’re thinking.’ ”
- One question at a time. Jones recommends limiting yourself to a single question that will hopefully spark a short dialogue with the doctor. For example, if you’re still unsure about a recommended treatment plan even after you’ve discussed it thoroughly, try asking something like, “What other options did you consider?” You can definitely ask a few follow-up questions, but remember that keeping the discussion on topic will allow you to obtain the most helpful information in the quickest amount of time possible.
- Don’t tolerate a timekeeper. While a doctor’s time is limited and valuable, Jones advises caregivers to reconsider working with any physician who won’t take a few minutes to talk about a loved one’s condition. “The concept that doctors don’t have time is a fabrication. They’re busy, but appointment time should be dedicated to fully exploring your concerns,” Jones assures.
- Do your homework. Jones encourages patients to use the Internet and other resources to learn about relevant medical conditions and treatments. Caregivers can bring the information they find to appointments and use it as a jumping off point with their loved ones’ doctors. Just remember that some Internet-based medical materials are actually advertisements in disguise. Tell the doctor what you learned and then ask, “What do you think about this information?”
It’s true that talking to your loved one’s doctor may never be a truly ‘comfortable’ experience, particularly when an older adult is faced with a complicated health concern. But, as Jones says, it’s important for caregivers to “invite physicians down from their pedestals.”