{"id":4918,"date":"2010-03-08T07:00:33","date_gmt":"2010-03-08T12:00:33","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=4918"},"modified":"2018-04-02T23:38:59","modified_gmt":"2018-04-03T03:38:59","slug":"patient-to-doctor-why-arent-you-harder-on-me","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2010\/03\/patient-to-doctor-why-arent-you-harder-on-me.html","title":{"rendered":"Patient to doctor: “Why aren’t you harder on me?”"},"content":{"rendered":"

A joint post by e-Patient Dave and Dr. Danny Sands, written from alternating points of view.<\/em><\/p>\n

Danny:<\/em> An important moment happened a few months ago during office hours – important because it brought a profound shift in Dave’s view of the doctor-patient relationship. And that’s a vital part of participatory medicine.<\/p>\n

Dave:<\/em> As many of you know, my primary physician is Dr. Danny Sands. I was there for my annual check-up.*<\/a> \"Danny<\/a><\/p>\n

He was late as usual – regardless of the economic pressures on doctors today, he declines to rush: he spends as much time with each patient as he finds necessary. I’m accustomed to this, so I bring work to do while I wait. (There are many aspects to being an empowered partner engaged in the healthcare system!)<\/p>\n

Our visit went fine: nothing dramatic, a few minor complaints, updates on issues we’d covered before. My cancer’s in the past – I’m now just an ordinary middle-aged schlumpf. As our visit came to a close, the doctor’s main advice was “You should lose weight.”<\/p>\n

And that’s where it got interesting.\u00a0 Because earlier in the visit he’d mentioned a patient he’d seen earlier in the day, whom he’d lectured pretty strongly about not sticking to the plan. But after he discussed that my <\/em>weight had gone up, in a really not-so-good way, he just finished the visit – with no lecture.<\/p>\n

I thought, that’s odd: he lectured the other guy, not me. Feeling bold, I spoke up: “So, why aren’t you harder on me about my weight?”<\/p>\n

Danny:<\/em> I stopped, reflected, and realized: I’m hard on someone if they complain about things resulting from a lifestyle issue, and aren’t doing anything about it. Dave wasn’t making the best choices he could, but he doesn’t complain.<\/p>\n

But I thought, why not document this? So I sat back down at the screen, turned it so the patient could see it, and following the five items we’d already discussed, I typed: “6: Obesity.”<\/p>\n

I added comments about his need to address it, and told him verbally: “It’s my job to give you the information, but you know what you need to do.”<\/p>\n

Dave:<\/em> That was a perfect expression of our 2008 post about Stanley Feld’s “Physicians are coaches. Patients are players<\/a>,” echoed here in July<\/a> by ICSI president Kent Bottles. (Great comments on that post.)<\/p>\n

So the interesting question to me is, why was the coach hard on the other guy, and not me?<\/p>\n

Danny:<\/em> People respond to information. I use different approaches for different patients: (some need a nag, some just need the information; in industrial settings all we need to do is let people know their productivity and they’ll know what to do. Same thing in medicine: If you tell a doctor they have a low proportion of patients who’ve had a necessary test, they will improve their performance, but without the data they won’t do it. There are patients like that too.<\/p>\n

I’d probably misjudged Dave’s need on that scale. He had the information but still wasn’t acting on it.\u00a0 I could have been harder on him.\u00a0 While some patients respond well to my tough remarks, there are patients who don’t take to that at all well.<\/p>\n

Dave:<\/em> And it dawned on me: in my relationship with him, I’d been making it all about me – it hadn’t dawned on me that he needs the people skills to deal with the whole spectrum of patient personalities.<\/p>\n

This is fascinating to me. The more I learn about being a full colleague <\/em>in my care, responsible not just for my own health but for our relationship<\/em>, the more I appreciate the range of skills clinicians need.<\/p>\n

When I got really really<\/em> bad news about terminal cancer, Dr. Sands was supremely calm, gentle and clear; but day by day, he also needs agility and grace in adapting his style. Oh yeah, then there’s the medical knowledge. That too.
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Participatory Medicine takeaways:<\/p>\n