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« Ammunition for Your Doctor Visit | Main | Making Your Case at Doctor Visits-Part II »

June 10, 2011

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Lisa Weiser

Wow, Wendy! While I generally like the points you made in your previous post all of your suggestions here seem to protect the ego of the doctor. I need my doctor to protect ME--whether being reminded of it bruises his ego or not. The doctor may or may not be in expert in his or her field but ultimately I am the one who must live with the consequences of the choices made regarding my care. Some doctors simply don't like to be disagreed with and while I try to respectfully discuss treatment options with my doctor unfortunately I do sometimes feel that I need to "arm" myself. It's not the way it should be but, unfortunately,sometimes it is the way things are.

Wendy S. Harpham, MD

Dear Lisa,

Every clinician-patient relationship is unique, which is why my conclusion focuses on finding ways that work for you and your physicians.

I agree: Your physicians' responsibilites include advocating for you. And, yes, the patient lives with the consequences of treatment decisions.

When being cared for by a physician who demonstrates intolerance to patients' questions or requests, going to doctor visits "armed with ammunition" still hurts the patient.

In my mind, this approach should be a last resort, after other efforts have been made. I'll suggest a few in my next post.

With hope, Wendy

Jan Hasak

I think the best qualities of a doctor-patient relationship are personal rapport and mutual respect for each other's position. These will go a long way to create a win-win situation. If the rapport and respect are not there and insurance allows, I suggest finding another doctor who fits (not just gives you) the bill.
Jan

Marcy

I am intrigued with this exchange, partly because I agree with both. I have gone with a pageful of questions to my oncologist, without time to finish them all. I have gone with reports of "how it's done at the best hospitals in the States" (not my place of residence) for my type of cancer, but my "ammo" didn't move him at all. But we always had friendly exchanges and he would kindly report me as an "inquisitive" patient. The most recent report referred to the "well-informed" patient. I'm sure it's because of a generous measure of grace on his part, but I also think a key phrase in Wendy's post is "adversarial stance." Even with the right language, the way something is said can make all the difference.

Denise

I have had wonderful relationships with my past and current oncologists. I frequently send thank you notes after especially good appointments, as well as holiday gifts. I express my gratitude often and in many ways. But I would never use the suggested phrases in talking to my doctor. We are at all times equal. My opinion deserves as much weight as his. And, I am the final decision maker on care issues. To behave otherwise would be disingenuous. Hopefully, paternalism in medical care is on the way out.

Wendy S. Harpham, MD

Denise,

Thank you for this useful feedback. For sure, patients are the final decision makers on any care issue. If my post suggested otherwise, I need to clarify in future posts.

But, unlike you, I do NOT feel equal with any of my physicians. I need them more than they need me.

They know more about my disease than I do. More importantly, even if I did know as much lymphoma-oncology as they do I can't have the objectivity needed to make wise decisions. I believe in Osler's adage that a physician who treats himself has a fool for a patient.

I look forward to your comments on future posts that deal with this topic.

With respect and hope, Wendy

Finn

I also don't feel like my doctors and I are equals. If that were true, it would mean that I'm seeing them only because they have prescriptive authority and I don't, or because I can't operate on myself. I go to them because they have the expertise, based on both training and clinical experience, to determine a course of treatment in keeping with my needs, abilities, and preferences, as well as to maintain and improve my health. Of course we are "equals" in the sense that we all are under the law, but in terms of maintaining and improving my health, I am no more their equal than I am the equal of my mechanic when my car starts making an odd rattling noise.

Of course, acknowledging our doctors' greater expertise doesn't mean nodding like bobbleheads during medical appointments and doing everything we're told without discussion like obedient children. We are the ones with expertise on our lives, including our previous treatment experiences, financial resources, work and family obligations, and of course we are the ones who have to live with the treatment results, so we definitely have "more skin in the game" than our doctors.

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