Pamela A. Popper, Ph.D., N.D.
Wellness Forum Health
I’m writing this article to provide some guidance for patients about how to have more productive discussions with their medical doctors. One of the services we provide at Wellness Forum Health is information and data that facilitates informed medical decision-making. Our members maintain their relationships with their medical doctors and often return to them equipped with evidence, ready to engage in more collaborative discussions about care. These discussions can include things like medication reduction or withdrawal, diet and lifestyle change, and other evidence-based solutions for health issues.
The responses from doctors vary. Some doctors are simply not receptive to patients being more involved in decision-making, changing directions regarding care (reducing or eliminating medications, for example), or the process of reviewing several potential solutions to health issues. My contention is that in most cases, people should “fire” a doc who does not embrace a collaborative and evidence-based approach to patient care.
Some people are afraid to stand up to an uncooperative doctor. But healthcare is (or should be) a consumer service, and the objective should be to make the consumer happy. When people make other consumer purchases, they do not “take orders” from professionals. Rather, they obtain information, evaluate it, and then make their own decisions. No one purchases a car because the car salesman knows so much about cars that the purchaser’s preferences make no difference; or buys furniture he does not want because the decorator knows more about how the living room is supposed to look than the homeowner. But somehow in medicine, even strong-willed people sometimes say “yes” to things that they do not want to do because authoritarian doctors conduct themselves in a manner that does not invite discussion or disagreement. Hence, the recommendation to fire the non-cooperative doc and find a new one.
Finding a new doc can be somewhat challenging, but asking people you know is a good way to start. There are good doctors who are interested in patient feedback in almost every community, or within reasonable driving distance of every community. It’s worth the time to ask around, call and talk to staff (the staff can often explain the doctor’s patient approach), and schedule an appointment to interview and get to know a doc who sounds promising.
Whether you are approaching one of your current docs, or a new one, I think there are a few key things to keep in mind. First, make the discussion about evidence. You are much more likely to get a positive response from doctors if you have information and articles in hand, instead of just reporting what others (including us) have told you. Doctors are legitimately wary of unsubstantiated information and advice from neighbors and golfing buddies, and even organizations like ours. A discussion that starts with referenced information will almost always lead to better outcomes. Additionally, you’ll be a much more active and confident participant in the discussion if you stick with the evidence.
Another thing – and this may sound strange coming from someone like me who has historically been critical of doctors – keep in mind that your doctor has most likely never seen anyone get well as a result of some of the things you might propose, such as changing your diet, engaging in exercise that has been shown to resolve musculoskeletal issues like yours, or seeing a cognitive therapist while withdrawing from psychiatric drugs. So don’t be surprised if your doc is skeptical about your new plans. You might be the first person to get well using these types of strategies. This may inspire your doctor to learn more about such things, and/or be more receptive with the next patient who decides to address health issues differently.
The way that you present information to your doctor can make a difference too. In medicine things tend to be evaluated in black and white terms, without much gray area. You will either take medication or not; or have a particular procedure or not. But the answer may be much more nuanced than just a “yes” or “no” to the proposed test, drug, or procedure. Let’s take a patient who has been recently diagnosed with cervical dysplasia as an example. The usual recommendation is colposcopy followed by a procedure. Instead of just saying “yes” or “no” to these suggestions/instructions, you could propose as an alternative dietary change and weight loss, and another follow-up PAP test in 6 months. If the dysplasia is resolved, fine; if not, you agree to the colposcopy at that time. This plan sounds much better and more reasonable to a medical doctor than just saying no to colposcopy with no alternative strategy in place. A collaborative relationship with your doctor requires you to share more information and disclose more too. Doctors have a tendency to want to do something in response to almost any abnormality (which is one of the reasons we should stop looking so hard for abnormalities), and when you say “no” to a recommendation, a doctor often interprets this as meaning “I’m not going to do anything about this.” Dietary change, exercise, and other related activities are not “doing nothing.” They are alternative plans to a proposed plan, along with the safety net of additional tests to confirm that the strategies have worked, or not.
Of course, remember that the decisions are ultimately yours to make. While your doctor’s opinion may be helpful and good to know, it’s your body, your life, and you alone will have to deal with the consequences of the care you agree to receive. Additionally, research is quite clear that the patient’s confidence in treatment plans influences outcomes. You need to feel good about the choices you make, rather than feeling like you were talked into or badgered into agreeing to something that you did not want to do.
So do your homework, show up ready to have an informed discussion, present your evidence, maintain the courage of your convictions, and feel free to fire your doctor and find another one if you are not satisfied with the way things go. There are good docs waiting to see you!