Tag Archives: physician-patient relationship

Can Long-Term Physician-Patient Relationships Be Bad For Your Health?

I wonder how many problems like non-compliance, usually attributed to “poor patient behavior,” actually stem from long-term physician-patient relationships in which both parties have just given up.

You know what I mean…physicians who have treated certain patients long enough that they believe they are just plain never going to do what they are told…and patients with expectations for care and service from their physician that never seem to be met.

Like any long-term relationship, people become used to one another and develop coping mechanisms to avoid an outright breakdown.  People in long-term become complacent with one another’s “quirks.”   We are all too willing to settle for the things as they are and not push the boundaries of the relationship hoping to improve it.

But there is a long-term cost to the patient and physician when we ”settle” and try to just get by as the graphic below suggests.

At face value, most physicians and patients don’t do a great job when it comes to communicating with one another.  Take patient expectations .

Most people have certain basic  expectation for what we want to happen when we consult our physician.   At a minimum we expect to have the time and opportunity to tell the doctor why we are there.   After all, if we are concerned enough to make an appointment we want to be heard.  Maybe we also have an expectation for a specific service – say a test, a referral or a new medication.

Quite often however, patient’s expectations, reasonable or not, often go unmet.  According to researchers, physicians failed to ask for patient’s full reason for their visit in 77% of visits.   Maybe the physician has little time to allow the patient to ramble on or maybe the physician has already arrived at a diagnosis already.

The reality is that the patient’s expectations were unmet perhaps resulting in disappointment and perhaps frustration.  Unfortunately, as Avedis Donabedian, MD, once said, “patients are overly patient with their physicians” and are willing to put up with a lot without saying anything (or reporting it on patient satisfaction surveys).

Not every patient request for a test, referral or medication is appropriate.  Physicians have an obligation to deny inappropriate patient expectations.  But again, depending upon how well the physician explained their reasoning for the denial, some patients will be disappointed and perhaps even angry.   Another study found that 56% of patients expressed an expectation for a specific service – a test, referral or medication… with 50% not getting what they asked for.

Now imagine playing this scenario playing out between patient and physician 2 or 3 times a year over a number of years.   I have to believe that in situations like this patients continually lower their expectations of their physicians…and along with it their trust, willingness to share information, and a willingness to comply what the physician recommends.  Physicians for their part probably reciprocate these feeling in some way.

The point is that settling and being complacent can be bad for the patient’s health and very unsatisfying for the physician.   Too bad we don’t measure patient and physician complacency…it could probably explain a lot.

That’s my opinion…what’s yours?

Sources:

Dyche, L. et al.  The Effect of Physician Solicitation Approaches on Ability to Identify Patient Concerns.  Journal of General Internal Medicine. 2005; 20:267–270

Peck, B. et al.  Do unmet expectations for specific tests, referrals, and new medications reduce patients’ satisfaction? Journal of General Internal Medicine, 2004; 19(11), 1080-7.

Patient Satisfaction and Doctor Requests – What’s the Score?

[tweetmeme source=”Healthmessaging” only_single=false]My favorite blog, besides Mind the Gap, is KevinMD.com.  It’s not just because they let me do a guest post now and then.  I like it because it is a great place to interact with lots of other readers, particularly physicians.
 
Last week, KevinMD picked upon my post here on empathy or should I say the lack of it.   True to form, I received some engaging comments.   One comment in particular caught my attention.  The contributor for some reason equated “being empathetic” with “giving in” to patient requests presumably during routine office visits.  Here’s a direct quote:
 

Give the patients what they want! Antibiotics are OK for colds. The patients want them. So what if narcotic-addicted patients get more pain medication. That’s what they want. Why make a big deal about a patient’s weight or a patient’s smoking habits? It will upset them.

 
It then struck me that I hear variations on this theme quite often from physicians.   I interpret this to mean that some physicians are afraid that saying no to a patient request may negatively impact their patient satisfaction scores.   I can see why one would be concerned about this issue so I did a little research to see where the truth lay.
 
First of all, patient requests are not uncommon.  For example, a sample of 200 patients (closed panel HMO) generated 256 requests for service, e.g., medications, tests, and specialty referrals.  Treating physicians complied with most frequently with patient requests for medications (75.6%) and tests (71.4%) more frequently than expectations for referrals (40.8%).  So what was the impact of these physicians “saying no” figuratively and literally on patient satisfaction and patient trust?  Nothing. Patient satisfaction and trust in their physician remained high regardless of whether patient expectations were met or not.
 
When patients make requests, I really wonder what they are asking for.   Do they really want/need that antidepressant which they ask for u name or do they just want their physician to listen to them; yes even empathize with them? After all, the number one complaint of patients is that their doctors don’t listen to them.  Do patients make requests because they worry that their doctor is too busy to notice a problem like anxiety or depression?  I suspect that negotiating patient requests is not a big concern in physician practices characterized by strong patient-physician relationships and high quality physician-patient communications.  I could be wrong…
 
What do you think?
 
Sources:

Koropchak CM, Tulsky JA. Behind Closed Doors – Management of Patient Expectations in Primary Care Practices. Archives of Internal Medicine. 2007;167:445-452.

Vega CP. The Satisfied Patient – Overprescribed and Costly. Medscape Family Medicine. 2010:3-6.