Inside Medicine: Truthful discussions are key to effective treatment
By Dr. Michael Wilkes
A report in the British Medical Journal describes the process patients go through to avoid being perceived as aggressive or pushy because they don't want to upset the doctor. When the doctor asks us how we're doing, we tend to be overly cheery and positive, based on a social norm of not wanting to upset or disappoint someone in an important position. One sick patient explained that the fewer questions he asked, the happier the doctor seemed, the less behind the doctor got in his schedule and the more the doctor seemed to like him.
A secret is that doctors also need to be liked. Believe it or not, we are human and need positive reinforcement. In all fairness, I would be remiss to not point out that our employers are now also interested in measuring how much our patients like us (or how "satisfied" they are with us).
In his new book, "When Doctors Become Patients," Robert Klitzman, a psychiatrist, describes his surprise at learning that when doctors become patients, they also assume this role of not wanting to upset or disappoint their doctor. The doctors-as-patients also avoided asking tough questions and never confronted their physicians directly out of fear of offending or upsetting them.
A patient of mine says she feels that if she brings the doctor a little treat at each visit, the doctor will be more likely to remember her. She doesn't want to be just another patient – she wants to be special in case there is a time when she really needs medical attention. The doctor perceives these favors as signs of admiration – not a bribe or an attempt to curry favor – and such gifts are usually warmly received.
However, if the result of all this verbal and nonverbal social interaction is that the patient leaves my office without asking me important questions, or failing to share additional symptoms, we both lose.
Admittedly, the face time between doctors and patients is at an all-time low. Doctors are rewarded for doing things to people rather than talking with them. Given a 10-minute appointment, there is no way we can squeeze in everything that needs to be done in one visit.
But the agenda for each appointment needs to be a joint decision, and if the patient is timid or unwilling to be honest, no one benefits.
I know it is common for patients to tell me what they think I want to hear, not realizing that what I really want and need to hear is how they actually feel. In this crazy modern world of ours, we have far too few opportunities to tell people what's really bothering us. Our families often live in distant locations, our friends have their own problems, and we don't want to worry our spouses and children. So, as my kids say, we suck it up.
But the doctor is the one person with whom you should be able to talk. Tell your doctor that you're feeling low, that you're not getting along with your spouse, that you were fired last week. Do not be embarrassed to pull out your list of concerns.
We can't always solve the problem, but we can listen, and perhaps you'd be surprised how much the doctor can help.
About the writer:
Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at firstname.lastname@example.org