I Am the Skeptical Patient . . . Until . . .

Posted on December 27, 2022

Dear Doctor, As a patient - I admit to being . . . independent of thought, prone to inquire, even challenge at times, by asking questions particularly when, as I sit across from you or on the exam table, I am interrupted while explaining the circumstance that has brought me to this visit. Looking at the notebook screen much more than you look at me is also disrespectful. Sure, you’re busy. So am I.

Dear Doctor,

As a patient - I admit to being . . . independent of thought, prone to inquire, even challenge at times, by asking questions particularly when, as I sit across from you or on the exam table, I am interrupted while explaining the circumstance that has brought me to this visit. Looking at the notebook screen much more than you look at me is also disrespectful. Sure, you’re busy. So am I.

Patient office visits are scheduled in increments of 15 minutes. A follow up appointment from a previous visit – 15 minutes. An annual Exam 30 – 60 minutes (based on what insurance will reimburse for). Any interruption by the patient, asking questions, balking at, even challenging the prescribed next steps (tests, medication, etc.), disagreeing with the diagnosis begins to “back up” the schedule.

I am aware my tone of skepticism frustrates the person in the white coat sitting behind the computer screen. However, to be fair, and as a very healthy person with a good deal of knowledge and experience in the workings of our fragmented healthcare system, I am not going to be a “good” patient and blindly accept what I am told as fact without question.

As a former office nurse and practice manager, I know doctors lament having patients, like myself who “muck” up the schedule. How dare those of us who are inclined to ask questions because, as owners of the bodies we reside in, we are not (yet) convinced extra medication, testing, or any other “next step” is warranted.

Please do know, when I come to you it is first and foremost for the purpose of relationship – of getting to know you as I expect you getting to know me. You see, when it comes to my health, I come seeking your counsel. As with any relationship, professional or personal, you have expectations as do I.

Should you want me to drop my barriers, kindly consider the following suggestions:

1. Help me build my trust in you. If you expect I will adhere to your advice, you need to earn my trust. When you are in the exam room with me for those 10 – 20 minutes, be entirely focused on me. Even if you are in a hurry, I don’t want to sense it or see it. If I respectfully disagree with your assessment or plan help me to understand my misunderstanding.

2. Spend time with me. Familiarity builds trust. If you sense something is a bit askew with my lab results, don’t expect that I’m going to be comfortable with a 3-month follow-up. The more I see you, the more likely I’m going to trust you.

3. Keep up to date. If you are going to expect me to benefit from your advice, I expect you to be up to date with the literature. I will have done my research and prepared questions for the visit – which leads me to my next point.

4. Confront patients tactfully. Like myself, patients who do research on the Web, that you may not be in agreement with, don't want or need to be scolded. Even if you don’t agree with my findings, appreciate that I have taken the time to come into the conversation prepared to the best of my ability. Debating the issue is not an effective approach to gain or hold my trust in you.

5. Explain your reasoning. Communicate clearly, without talking down to me so that I can understand your thinking. I may not like what you are saying, but I will respect the message.

6. Acknowledge uncertainties. Be up front with me. Don’t present the science as far more certain than it is. If you are uncertain, and acknowledge such, and you have my trust, I will accept “the grey zone.”

7. Don't use a lot of numbers. I view over use of data as a distraction. It is not a good tool to convince me or most patients. If you want to use numbers to show clinical risk, then do so in a manner that can be appreciated.

8. Except shared decision-making. I am the patient, it is my health, my disease. Provide me with where I can find locate information. Support that I will do research.

9. If the prescribed treatment does not provide relief, expect that I will in all likelihood push back.

10. If you believe I am not weighing the risks correctly. Tell me so, in a respectful manner.

As with all relationships, trust is the key. Based on the experience of my caring profession, establishing a patient bond is a key piece in healing. I, and undoubtedly many of your patients, will take comfort in knowing I (we) are safe in your care.

CarolAnne

CarolAnne Dube, MSc, BCPA is the founder and CEO of Patient Advocates of Southwest Florida, LLC. The practice is focused on guidance, support and strategies for those seeking solutions for medical and health care challenges or concerns for themselves and/or those they love.