“The more specific patients are about the nature of their concern, the better,” says Dr. John Halvorsen, associate dean of community health of the University of Illinois College of Medicine in Peoria.
“If patients are aware they’re going to get some of these questions, they’ll think about it ahead of time,” he says. “That would help the physician zero in more quickly and probably more accurately.”
Halvorsen isn’t just throwing out kindly doctor talk.
While patients have grown to expect tests and technology to pinpoint medical problems with the precision of a “Star Trek” laser beam, the patient-doctor dialogue is just as important, if not more so, than the latest gizmo. According to the American Society of Internal Medicine, an estimated 70 percent of all correct diagnoses are made by talking to patients.
The doctor is no longer just a doctor, but is a “health-care provider.” The patient is no longer just a patient, but has become is a “health-care consumer.” New definitions call for new ways of looking at the doctor-patient relationship, not the least of which is the old-fashioned doctor’s visit.
Pamphlets and articles entitled “How to Make the Most of the Doctor’s Visit” are becoming as commonplace as brochures and articles on “How to Buy a Car.”
“Patients really need to be more assertive; doctors learn more from patients than anybody else,” says Dr. Jane Orient of the Association of American Physicians and Surgeons and co-author of a booklet entitled “For Patient Power: The Patient’s Handbook.”
Although doctors are supposed to be skilled in eliciting the information they need, Dr. Orient notes that nobody really explains to patients what kinds of information doctors need.
More accurate diagnoses are not the only byproducts of positive patient-doctor dialogues. A mounting body of evidence suggests patients who ask questions and make sure they understand their medical information do better.
Kaplan and Dr. Sheldon Greenfield have spent more than 25 years studying the dynamics of doctor-patient visits. Their findings have been quoted widely in articles and brochures on enhancing the doctor’s visit. Among the findings:
• The average patient gets to ask four questions in a 15-minute visit.
• They usually forget or hesitate to ask the most important ones.
• Men ask far fewer questions than women, though they tend to ask female doctors more questions than they ask male doctors.
• In several Kaplan-Greenfield clinical trials, patients with diabetes, hypertension, ulcer disease and breast cancer were given copies of their medical records, then coached on how to understand the records, what questions to ask and how to overcome shyness or embarrassment about asking questions.
Their doctor’s visits were then recorded and compared with a control group that had been given no special advice.
The study groups asked more questions, reported higher satisfaction with their doctor’s visits and were more likely to say their health status had improved. Many doctors, not only overwhelmed by insurers’ paperwork and managed care’s assembly-line approach but looking for a more satisfying relationship with patients, welcome the idea of well-informed, inquisitive patients.
Halvorsen is among the contemporary breed of doctors redefining the doctor-patient relationship from the old doctor-as-God model to a partnership.
“This whole patient-oriented model has started to take greater precedence, particularly within primary care disciplines,” he says. “My own sense is that it’s a good thing. It’s much easier to work with someone who wants to be involved in making decisions about their health. It also takes a big burden of the responsibility off the doctor’s shoulders.”