Tips for Doctors to Become More Patient-Centered
“First, do no harm” is a common expectation patients have of their doctors. However, over the years I’ve had a number of medical appointments that were carried out in ways that left me feeling more depressed, anxious, disregarded, devalued or vulnerable than I was before the appointment started.
I’ve had doctors who downplayed my symptoms or even seemed to disbelieve them because they “didn’t fit with my diagnosis.” I’ve been told we need to stick with the treatment plan because “it should work” even when it isn’t working at all. I’ve had doctors brush aside my reports that the side effects of a medication are as problematic as they symptoms it’s supposed to treat. I’ve even been told that some of my doctor’s patients “have it far worse,” suggesting that in seeking the best health possible I’m too high-maintenance.
The power the doctors hold
Doctors have a lot of power. We seek them out when we are our most vulnerable. Doctors have expertise, connections to other practitioners, and the prescription pad. We look to them for answers and help. When we are instead met with a lack of concern, respect, or compassion, it can feel like being kicked when you’re down. Pain, lack of sleep, stress, and discomfort all make it hard to advocate for ourselves, and one would hope self-advocacy wouldn’t be necessary with the disease expert. If any healthy person should understand how hard it is to live with chronic illness, it should be the doctor who treats it.
Some useful tips
While I have experienced terrible bedside manner, I’ve also had some amazing doctors who have always treated me as a valued individual. I’ve paid attention to the ways they work to connect with me as a human, rather than another name to scratch off of the day’s schedule. Here are some ways that doctors can let patients know that we matter.
Ask “How are you doing?” . . . and mean it.
In our society, we often ask “How are you doing?” as a greeting, and answer it with a routine “Good” or “I’m fine” out of habit. While most doctors will ask this question, asking it in a way that encourages the patient to respond honestly is important. Rather than asking how a patient is doing while breezing into the room with eyes on the chart or computer, when a doctor makes eye contact with me and asks this question in a spirit of empathy and patience, ready to listen, I’m much more likely to give an honest answer.
Remember something about me not related to my diagnosis.
No patient wants to feel that s/he is simply a conglomeration of symptoms. Rather, we want to be seen as whole individuals living with the symptoms we’re being treated for. Whether it’s a book I was reading at my last appointment, a hobby I’ve taken up, my job, or my family, when a doctor remembers something specific about me that doesn’t have to do with my disease, I feel like s/he sees me as an individual with a life bigger than my health condition. I highly recommend that doctors jot down a note about their patients where they can easily reference it at the next appointment.
Use humor (and hugs).
As long as a joke isn’t at anyone’s expense, humor in the midst of challenging circumstances can be welcome comic relief. Humor can connect us and help us see each other as humans rather than as simply “doctor” or “patient.” Similarly, physical contact, whether in the form of a handshake, a pat on the shoulder, or a hug can also connect us. It’s crucial that a doctor read a patient’s body language and not go for a hug if the patient doesn’t seem open to it. However, if there’s a warm doctor-patient relationship and the patient welcomes the contact, a hug from a doctor while going through a tough time can be very meaningful.
Ask for consent.
While touch can be warm and connecting, being poked and prodded in a medical appointment can make one feel very vulnerable. I have a specialist who asks for my consent each and every time she touches me. By asking, “Is it okay if I feel your throat?” or “Is it alright if I put the stethoscope under your sweater?” she ensures that I remain comfortable through each step of the exam.
Unfortunately, this frequently doesn’t happen. In an extreme example, I recently went for my first mammogram and was surprised and uncomfortable to have the technician manhandle my breasts to position them correctly on the machine without ever asking for consent. Yes, my consent is implied that my breasts will be touched when I go into a mammogram, but being asked, “I need to position your breast to get a good image. Is that okay?” would have gone a long way in making me feel less vulnerable and uncomfortable.
Walk through each step.
Just as consent should be requested at each physical contact in an exam, being walked through the particulars of a procedure or test eliminates some anxiety. If I don’t know why a test is being ordered or when the needle is about to stick me, I have more anxiety than when I know what to expect. Rather than leaning over and palpating joints, a rheumatologist who says, “I’m going to check your joints for swelling and tenderness. Is that okay?” makes the patient a partner in the medical process.
Similarly, it’s helpful to know why a doctor is ordering a test or procedure. There’s a huge difference between saying, “I’m going to order some lab work” and saying, “Due to the [specific symptom] you’re experiencing I want to run some lab work to see if [specific indicator] is involved and/or to rule out another underlying issue.” While a doctor doesn’t need to go into the specific details of the worst case scenario s/he is ruling out, explaining to a patient why a test or procedure is recommended can help the patient understand the process, thereby reducing anxiety.
Try to see things fromthe patient perspective.
While doctors need to keep their “doctor hat” on, trying on the “patient hat” momentarily is important too. When examining a patient’s symptoms or reporting on test results, keeping the patient perspective in mind can help the patient feel seen and valued.
For example, I have seronegative RA, meaning that I’m in the 10-30% of patients diagnosed with Rheumatoid Arthritis who do not show indicators of the disease on standard bloodwork. While x-rays, ultrasounds, and physical exams may indicate swelling, pain, and joint damage, my lab work consistently appears normal. Therefore, it’s frustrating to go to the rheumatologist and be told, “Well, your labs look good.” I frankly don’t care how the numbers look; I care about how my body looks (and feels). I would much rather the rheumatologist say, “Your lab results didn’t change,” as this would indicate that s/he remembers that while my numbers always “look good,” this doesn’t correlate with how I’m feeling.
Similarly, I’ve had doctors minimize my experience of side effects, focusing solely on the impact of a medication on my symptoms. However, I’ve had side effects that were as unpleasant and disruptive to my quality of life as the symptoms the medication was treating. Remembering to see things from the patient perspective keeps doctors from minimizing what’s important to a patient.
Don’t accept “good enough.”
I’ve had doctors who have settled on a treatment plan and stick with it even when I continue to have problematic symptoms, and I’ve had doctors who continue tweaking my medications and exercise/diet/alternative therapy recommendations until my symptoms are mild or have disappeared. When I feel like a doctor is in my corner working for the best quality of life possible, I feel valued and important. Even when all options are exhausted, having a doctor tell me, “I’m going to continue to research this” signals to me that my symptoms matter, and that in turn, I matter.
Do any of your doctors have great bedside manner? Please share any practices that make you feel valued as a patient.
Does your RA impact you financially?