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Communication is key to every office visit

Special to the Los Angeles Times

When it comes to doctors, people tend to be strongly opinionated. Some patients adore their physicians and feel they can do no wrong. Others complain about the doctors they see — for keeping them waiting, for poor bedside manner or because they doubt the physician’s clinical prowess.

Patients aren’t the only ones with opinions. Although doctors enjoy their interactions with most patients, they find visits with others downright unpleasant.

This issue is more common than most people imagine: Doctors describe almost 1 in 6 patients as difficult, according to surveys.

There are strategies doctors can use to help mend these strained relationships. They can, for example, hone their communication skills and strive to be as empathetic as possible. After all, patients face many frustrations — long waits, short appointment times and brusque and sometimes burned-out physicians.

But physicians have frustrations too. They work within an imperfect healthcare system that often doesn’t allow them the time or resources to provide the kind of care they’d like to deliver. They also have to deal with a wide range of patients and personalities who need not only outstanding clinical care but emotional support as well.

So it’s up to patients to help the interaction go more smoothly as well.

It all starts with recognizing what doctors might find irritating to deal with, and why.

Patients’ personalities play a significant role in how doctors respond to them. Doctors typically don’t appreciate patients who are abrasive or rude — who does? But the issues go beyond bad manners. Many physicians also struggle with patients who are incredibly demanding, highly emotional or extremely passive.

A doctor’s demeanor also comes into play. A physician who doesn’t like to relinquish control, for example, may find patients who are highly engaged in their own care annoying, while another doctor may appreciate this kind of involvement.

Research has identified a number of specific patient behaviors that irritate doctors. Doctors hate it when patients insist on being prescribed a drug or given a medical test that the physician feels isn’t necessary. While patients may feel they’re advocating for themselves, doctors often view this kind of pressure as manipulative and a challenge to their professional judgment. That’s not to say that patients shouldn’t ask about drugs or tests they might have heard of — they should. But they need to be prepared to thoughtfully listen to the physician’s answer and not immediately dismiss the feedback.

Physicians grow frustrated with patients who visit regularly but largely ignore the medical advice they’re given. Only about half of all patients take the medications they’re prescribed as directed, for example. Compliance with lifestyle prescriptions such as weight loss and smoking cessation is even lower; fewer than 10% of patients successfully implement these types of behavioral changes over the long haul.

In many instances, the lack of follow-through is understandable — on an intellectual level. Medications may be stopped because they cause unpleasant side effects or cost too much money, and lifestyle changes are hard to make. On a strictly emotional level, however, noncompliance is frustrating to physicians who really do want to see their patients get better.

Doctors are very busy and get aggravated by patients who are unnecessarily time-consuming. This includes patients who fail to answer questions directly and concisely, turning simple “yes” or “no” questions into long stories filled with loads of unrelated details.

Perhaps more frustrating, however, are patients who come in with multiple unrelated complaints and expect them all to be addressed in the course of one short office visit. Although doctors would like to be able to deal with all of the issues, they can’t feasibly do it in the amount of time they’ve been allotted. Thoroughly evaluating a patient for headaches alone can take up an entire visit; evaluating someone for headaches, leg pain, heartburn and fatigue would consume the entire morning.

Patients often hold their doctors accountable for problems that arise between them. Somehow it’s the doctor’s fault if they don’t get along. If he had just been more compassionate or spent more time with the patient things would have gone more smoothly; if she’d explained things more clearly, had more experience or was less judgmental, the patient would have been better served.

Doctors also frequently blame themselves for these troublesome encounters, feeling that in some way they’ve failed. They search for ways to manage their practice and emotions differently in hopes of improving relationships with the patients they find most difficult.

But the physician-patient relationship is a two-way street, and both parties need to do their utmost to make the dynamic work.

Doctors need to do their best to listen and communicate clearly; patients need to really hear what their physician has to say. That doesn’t mean they can’t ask questions or even challenge their doctor. It does mean they can’t totally ignore the guidance and advice they’re offered.

Physicians need to be willing to work collaboratively with patients, but patients need to carry out their end of the bargain. It’s up to patients to follow through with the advice they’re given. No one can take their medications for them or make the lifestyle changes necessary for good health in their stead.

Doctors need to be clear about what they can and cannot realistically provide for their patients. For example, the length of a typical office visit should be spelled out upfront, and patients should be informed about their options if they require additional time. Patients also need to be thoughtful and reflective about what they can ask of their doctors. They need to recognize, for instance, that more than one visit to the doctor may be necessary if they have a host of nonurgent problems they want addressed.

In most instances, there will be a middle ground where both parties walk away satisfied. In cases where doctors and patients can’t see eye to eye, ending the relationship is probably the healthiest option for everyone involved.

Unpleasant encounters between patients and their doctors take a big toll on both parties. They leave doctors — as well as patients — feeling frustrated, angry and resentful. Negative interactions can ruin a doctor’s day and even undermine the way she or he feels about the profession. But it is the patient who potentially has the most to lose from this type of friction: Being perceived as difficult by a physician may actually undermine the quality of care received.

Like any relationship, the best results generally come when two people are working together — not locking horns.

Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. The M.D. appears once a month.

themd@att.net


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