Beyond Compliance, Adherence, & Concordance – Supporting The Patient’s Implementation Of Optimal Treatment

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The Rules For Doctors and Patients

August 12th, 2008 at 8:29 am · · Clinical Info · 1 Comment

Not These Rules

These Rules

Dr Rob at Musings of a Distractible Mind offers rules (recommendations, really) to improve the effectiveness of doctors and patients working together. I’ve excerpted one rule from each group to give a flavor of the others.

The only comment I’ll add is that I am more cynical than Dr Rob and have less faith in the power of logic and common sense to change ingrained behavior. Some patients, for example, I believe are psychologically unable to trust anyone, including their doctors. Regardless of the benefit they might derive from doing so, some folks are not able to follow the axioms to trust their doctors and be honest with them. And doctors are hardly immune from the same psychological forces. Nonetheless, I find Dr Rob’s Rules commendable in general and, if followed, capable of impressively reducing noncompliance.

Excerpt from Getting along: Part 1 – Doctor Rules

Rule 4. They [Patients] don’t want to look stupid. I remember when I broke my shoulder – a compression fracture of the neck of the humerus bone – and went to the orthopedist office. I always felt self-conscious about how much pain I was reporting. A colleague had fractured his humerus the year before and had reported he was back to doing surgery within a few weeks. Here I was, a few months out and couldn’t even lay down in bed. I felt like a wimp. Was this other guy just tougher than me? My orthopedist made me feel much better when he explained that my colleague had a mid-shaft fracture, while mine was right in the shoulder joint – a much slower place to heal. This event made me realize how many patients felt when they came into my office. People are often worried that they are over-reacting. They wonder what I must think for a person to come to the office with that symptom. This is especially true of parents bringing their children in. Nobody wants to be “that mother that over-reacts to everything.” In response to this, I try to specifically say, “I am glad you came to the office for this because…” or “Yeah, I can see how that worried you because it could be….”

Excerpt from Getting along: Part 2 – Patient Rules

Rule 2: Be Honest [With Your Doctor]. Nobody likes to look silly. I think the main reason most people are untruthful is that they are embarrassed about the truth. But sometimes symptoms are strange, like the man having a heart attack who described it as “a cold feeling when I take a deep breath.” Sometimes symptoms are embarrassing, like a testicular lump. Sometimes you just don’t want to feel like a wimp, so you downplay your pain. While I can sympathize with this feeling, I don’t see any good reason to be anything but truthful with your doctor. Yes, your symptom might sound strange. Yes, you may have flubbed up and not followed instructions properly. Yes, you may be afraid of what some of your symptoms may mean. But the goal is to fix (or prevent) problems, and trying to do that with bad information is an exercise in futility. We physicians hear it all. There are very few things a person can say to me in the exam room that will surprise me. My job is to help people, not judge them as “weird”, “crazy”, “wimpy”, or “panicky.” Don’t worry about making a good impression on your doctor. Just give the facts. That will give the best chance to get the desired outcome.

Tags: Clinical Info

1 response so far ↓

  • 1 Rob // Aug 12, 2008 at 11:53 am

    Thanks for the link. I actually am more cynical than my rules state. I do not think that posting these rules will have the desired effect any more than saying “stop smoking” to a smoker will make them change. The point is to simply point out the problem and then (with help from people like you) come up with solutions. I do agree that compliance is a disaster and much of it is due to lousy communication by the physician.

    Anyway, thanks.