In Sickness and In Health: The Doctor-Patient Relationship

By Jacqueline Holness

When *Malena Harold had a myomectomy last year, waking up from the surgery paralyzed was supposed to be the rarest of side effects from the fibroids removal surgery. “I had been in one position for too long and had nerve damage.” Following that negative experience, Harold began having trouble with another OB/GYN. “I could never get an appointment with her or when I did, she wasn’t on time so our time was compressed. We never got to my issues, and I was in a lot of pain.”

Harold enlisted private patient advocate Cindi Gatton’s help in finding the right OB/GYN for her and facilitating an effective doctor-patient relationship. Gatton helped Harold formulate her medical history into a story using a spreadsheet. “Compiling my medical history helped me to analyze the information and determine what I need.” Harold, who is refining her search through healthgrades.com and zocdoc.om, realized she needed an OB/GYN who specializes in fibroids and endometriosis treatment and doesn’t deliver babies. “I’m an older woman past that stage, and an OB/GYN who doesn’t deliver babies may have more stable hours.” Gatton also helped Harold formulate questions to ask potential doctors. “One of my top three questions I ask is, ‘In a perfect world, thinking about your best doctor-patient relationship, how do you want your patient to interact with you?”

Dr. Danielle Ofri, who is a physician at New York’s Bellevue Hospital and author of “What Patients Say; What Doctors Hear,” says, “The doctor-patient conversation is the single most valuable diagnostic tool in medicine.” Through experimentation, Ofri discovered that patients will tell doctors information essential in diagnosing medical conditions if they take the time to truly listen to their patients at the beginning of a typical doctor visit. “I don’t do anything other than listen to the patient at first because I’ve learned that most patients will tell me everything they need to tell me in about two minutes. It’s actually a lot of time if you give someone full attention and don’t interrupt. Then you might say, ‘I would like to take notes so I don’t miss anything.’ So then I incorporate the computer, but I’ve already made the investment in a good relationship.”

As the American health care system has experienced major upheavals due to the shifting political landscape affecting the Affordable Care Act and the overall fragmentation of care, private patient advocates demystify the system for clients. One service Gatton provides for clients is preparation for doctor visits. “As patients, we have to own our health history and medical records. Document chronologically your conditions and important health events on an Excel spreadsheet or use websites like picnichealth.com or caresync.com.” After compiling the information, Gatton suggests highlighting critical issues to be discussed during doctor visits. “Before you go to doctor, concentrate on three things beforehand. It helps you to stay focused and helps the doctor stay focused as well.”

Since typical doctor visits last 10 to 15 minutes including three to five minutes allotted for “face-to-face time with a physician,” Dr. Walkitria Smith, who is an assistant program director for Morehouse School of Medicine’s Department of Family Medicine, says she conducts 40-minute annual wellness visits for patients 65 years old and older. “These are typically my patients with complicated medical histories and who are on several medications. These visits allow me to do health maintenance, but they also help me to build my relationships with them too.” Smith also encourages patients to e-mail her using Patient Portal. “I tell my patients that I’m not always in the office 24-7, but I’m good at getting back to my messages within 24 hours.” Smith’s attention to fostering effective doctor-patient relationships has not gone unnoticed. Al Branch, whom Smith treats for hypertension, says, “As a woman of color, she is familiar with challenges that black men face health-wise and mentally.”

In addition to diverse perspectives on care, cost concerns often hinder effective doctor-patient relationships. Expensive but not emergency procedures, as determined by the doctor, can be postponed, says Gatton. “For example, if you need to get an echocardiogram and you don’t know how much it costs, whether it will be less expensive at the hospital or an outpatient center down the street, you can always say, ‘Can I follow up with you on that?’”

Chronic illness treatment, which requires repeated conversations, can be negatively impacted by the health insurance industry, says Ofri. “If I talk to a patient, I get reimbursed, but if while I’m talking, I stick a tube into an orifice, the reimbursement goes up 10 or twentyfold. Just by that fact alone, you can see the system is more geared toward procedures and not talking.”

All of these factors underscore why finding the right doctor is important. “I’m very rigorous in my research,” says Harold.