Abstract
Keywords: Physician-patient communication, patient-physician communication, patient engagement, participatory medicine, health data.
Citation: Johnson R. An e-patient’s frustration. J Participat Med. 2012 Aug 30; 4:e19.
Published: August 30, 2012.
Competing Interests: The author has declared that no competing interests exist.
To the Editors:
John Krueger’s article, “The Patient Will See You Now,” is spot on. A recent encounter with my health care provider confirmed what is already known about our health care system. My cholesterol levels have always been through the roof, and I have a family history of heart disease. Never have any of my annual physicals produced any course of treatment to effect changes in my lipid profile. I always got the same notice from my physicians: “Your cholesterol is high.”
Recently I took control of my diet, specifically to address the high cholesterol levels. I eliminated meats and dairy from my diet, with the understanding I gathered through my own research that ALL meats a dairy contain saturated fats and cholesterol. I increased plant-based foods, beans, and fruits. When I informed my doctor that I was changing to a plant-based diet, he asked me, “What is that?” Strike one.
As a self-controlled experiment and with no exercise, and only a diet change, in the course of four months I lost 25 pounds of fat off my stomach, my waist went from 43 inches to 37 inches (and still getting smaller), my HDL went from 38 to 60 and my LDL went from 205 to 109. My blood pressure went from 190/85 to 117/70. Remember, this was achieved by my own diagnosis, research, and execution.
Then I compiled my blood test results from 1988 to present, to see if a trending analysis would reveal any issues that I should be concerned about. Indeed, my cholesterol levels were my main concern. Since this type of data was never presented to me at any doctor’s appointment, I thought that doing the work myself and presenting this to my physician would help my physician better understand my physical history. I forwarded the data to my physician via email and his response was, “… If you have further questions or concerns please make an appt. to discuss as I have limited time for ongoing email due to my schedule….” Strike two.
Now, for me to make an appointment to see my physician would require a four to six week wait. Seems email interaction would be a preferred method to efficiently communicate with a known patient. Bottom line for me, from a patient perspective, is if I do the research, provide a self-diagnosis, prepare a treatment plan that works and produces measurable result, then what am I paying for? Strike three.
Seems the business aspect of health care delivery has taken control. When I sit with my physician during the mandated 15-minute allotted time for any appointment and speak with him as he is filling in all sorts of computer data entry fields, I wonder how much of what I’m telling him is really being heard.
Copyright: © 2012 Roger Johnson. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.
Doctors are trained to recognize and treat symptoms with FDA approved drugs. They are not nutritionists and are not allowed to recommend any herbals or alternatives to “accepted” methods of treatment. The old adage of “you are what you eat” is sound advice. Meat should be a treat, not what our main course is.
Excellent example of how health care continues to look. Yes, I understand about the “harried and rushed” primary care provider. But, as I see it, the patient does have options.
We can vote with our feet — and I have done so. Once when told that “I only have 15 minutes for this appointment” as the physician looked at her watch, I said as I got up to get dressed, “Well, then let’s not waste your precious time with me.” And I left never to return.
This leaves one question: why on earth did you want to see your doctor? Your problem is solved. Can’t imagine the use of a visit to a health care professional for this issue.
Health care is for situations where people need care, and I don’t think you do at this moment.
Any reaction will be appreciated.
I changed specialists after a visit where the MD rarely made eye contact with me and had to have a scribe to enter the information in their EMR. He told me I had cataracts and put off having surgery as long as possible secondary to having an autoimmune disease. He had no other suggestions and was very impersonal. I am medically savvy enough to try to research online and find another specialist and another academic medical center, which I did. I saw another specialist three weeks later. He sat down, made eye contact, told me “This is what I’m hoping to get out of our visit today, what is it you would like to get out of this visit?” He apologized for needing to enter info into the computer, but, he continued to stay engaged. He was much more thorough and diagnosed me with not only cataracts but macular degeneration (which I didn’t develop in three weeks!) and even though there is no medication for it; he gave me information on special vitamins, explained how I should monitor my vision and gave me information to read and reputable websites. He also encouraged me to email him if I had further questions or if anything came up prior to my next appointment. Totally different experience.
As long as medicine is a transaction based business time will be money. The likelihood of getting good advice from doctors is slim to none and they will always work the system so that they get paid the most. Forget about having any more of a relationship with your doctor than you have with your UPS delivery person. Those days are over.
When you take responsibility for your own health the doctor is just another paid information source with a caveat emptor.
We all have exam room “war stories.” Even doctors, when they are in the role of patients, complain about how their doctors interact with them.
It isn’t always about money. Sometimes the problems come from misreading non-verbal cues, personality conflicts, and such. You know, all those things that cause communication problems in non-medical scenarios.
With a bit of thought, we can often turn things around with improved communication. For example, my husband’s PCP was ramrodding us through an appointment, interrupting questions, not listening to answers. He’d fallen into the pattern unintentionally. When I pointed out that I’d tried three times to ask the same question only to have him interrupt with the answer to the question he anticipated, he apologized and began to listen.
Once the broken communication lines were repaired, that doctor became my husband’s favorite PCP because he always took time to focus on listening and never interrupted a question again. And that made a huge difference in managing my husband’s chronic illnesses.
Sometimes it is about money, but often it is about communication. Patients can’t do much about a doctor’s money issues, but we can do a lot to improve communication. Let’s not blame all unhelpful doctors on financial transactions until we’ve made sure the real problem isn’t our communication transactions.