I am sure you have all experienced in the doctor's office not being seen on time, techs taking more tests without an explanation from the doctor, incomplete understanding of symptoms, lack of rapport with the staff and doctor, lack of communication, procedure-driven ideologies, expecting compliance without questions, discounting your desires, unmet expectations, being left in examination rooms for long periods, and being treated as a low-priority. So today, I want to talk about bad medicine, specifically the doctor-patient relationship, and how you can find good medical care.

My Recent Brush With Danger

In February, I posted about a surgeon who wants to perform a spinal fusion in my neck. Unfortunately, I spent only minutes with him the day we met, so, on the follow-up visit, I wanted to know why I needed surgery since I had no symptoms for over one year. The surgeon was surprised I had no pain, which disappointed me because he made incorrect assumptions that would have unnecessarily resulted in invasive surgery. 

Once I clarified that I had no pain, he told me my spine appeared to have many problems on my MRI from many months ago, and the surgery would help me if I ever got into a car accident and experienced whiplash. 

When I asked him, "That's it?" he became agitated and told me I was not like his other patients because they all were enthusiastic about having him perform surgery. I saw a bunch of feeble, obese, and sickly-looking folks in the reception area, so I was happy to hear that I was not like them. So, naturally, I told the doctor I agreed with him. I think he believed I should get in line like the rest of his patients. Either way, he was not happy because he started to get a bit adversarial. He told me that nobody dragged me off the street to see him. Of course, his partner referred me; I am sure he knew it. He was rude. 

Fraud and Incompetence

I remained calm and continued asking questions. I finally got the doctor to admit that surgery is recommended for patients suffering from myelopathy, a condition of pain, weakness, and lack of coordination from spinal compression. I did not tell him I knew this from reading numerous medical journal papers on the subject of spinal surgeries. Since I do not have myelopathy, he pulled a 180 and said he would monitor me. 

He intended to do surgery based on faulty information about me. Whether the surgeon knew I had myelopathy or not, makes no difference. He was either immoral or incompetent. Therefore, I will not be returning to him.

The God Complex Meets Savvy Marketing

Trust is a fragile state. Therefore, deception, even minor, and betrayals are met with strong negative emotions, especially when patients are ill, in pain, and frightened. Additionally, many offices promise miraculous care with no downside. Many doctors do the same when they meet their patients, as did the doctor I spoke about earlier. Such is the competitive world of marketing and the frailty of human nature. However, the downside is that patients may have unreasonable expectations that they will be seen promptly, receive treatment, heal quickly, experience little pain, and have no side effects, all of which will lead to disappointment, anger, and erode trust. 

How May I Not Help You? 

How often in life do you need services (not just medical) and meet with immediate resistance? Unfortunately, it seems to happen to me all of the time. As consumers or patients, we are supposed to do what they want, not get what we want. Of course, if our expectations are unreasonable, we will not get our way. But a good communicator will get us to understand and accept limitations without seeming insensitive. 

The Interview Technique

My (potential) surgeon made a huge mistake; he did not interview me. All good initial encounters should involve an interview that serves three functions; gathering information, developing and maintaining a therapeutic relationship, and communicating information. Patients encouraged to ask questions and participate in their care are more satisfied, have a higher quality of life, and are healthier. Additionally, United States law considers the doctor-patient relationship fiduciary. Physicians are expected and required to act in their patient's interests, even when those interests may conflict with their own. 1 

You are the Boss in the Patient-doctor Relationship!

I let all of my patients know this. First, all good medical practitioners should ask how they may help you. Next, they should ask us what we expect. 

Doctors should hear what the patient has to say, but they do not have unlimited time. Fortunately, they are usually not the first person to speak with the patient. Reliable staff who know the right questions when patients call can determine why patients want to be seen and give them the appropriate time to care for them.

The Importance of Good Support Staff

How often do you walk into an office only to stand in front of a person behind the front desk who is busy and won't even make eye contact to acknowledge your presence, let alone say hello, then hands you a clipboard? Since most patients may be in distress, they want courteous staff who recognize this and show empathy. Because the doctor-patient relationship is therapeutic, setting an immediate tone of apathy is dangerous. Beware the incompetent, uncaring, or rude staff member. Tell the doctor. If the doctor shows little or no concern, you may want to switch prctices.

Since many offices are large and complex, organization-level factors are required to help things run smoothly. For example, the accessibility of clerical and clinical personnel and their courtesy level provides a sense that patients are important and respected, as do reasonable waiting times and attention to personal comfort. In addition, the availability of treatment coordinators, auxiliary clinical staff, and doctors help patients feel they are being cared for in a caring and professional way. Leaving someone frightened and in pain alone in a small room for prolonged periods is simply a bad idea. Profit over compassionate care is wrong.

The Perils of Corporate Healthcare

Corporate-level management is mostly concerned with profit and loss. The doctor-patient relationship may not even occur to upper management as a concept. The caregivers are under immense pressure to help secure the bottom line, limiting critical personal interactions and vital communication.

Patients correctly wonder if doctors and staff care for them, their insurance plan, or their incomes. Unfortunately, this ambiguity erodes trust, promotes adversarial relationships, and inhibits patient-centered care.

Conflict of Interests

Ethics dictate that doctors attempt to ensure that their interests and patients align in clinical practice. However, insurance and corporate interests can pull physicians away from this goal, as the organization's values and their implementation inevitably influence attitudes, behavior, and experiences. Both patients and doctors feel a heightened sense of time pressure, and patients worry about being on a conveyor belt with a production-line-oriented doctor.

Individual patients with their needs and preferences may be considered secondary to following practice guidelines. This approach treats the disease without reference to the illness. The result is that individuals who merely have the same disease are treated in like manner, which may discount the patient's own story, thus discounting specific evidence about personal aspects of disease and its meaning and value. 

Functional Medicine and Dentistry to the Rescue

Western medicine often seeks only to address and treat symptoms, ignoring the patient and the actual cause of the symptoms. Functional medicine seeks to discover the nature of the body's function and its systems as they relate to the environment. The obvious mismatch in behaviors or the environment to the genetically expected norms is addressed and corrected. The more harmonious our environment and behaviors are, the healthier we are. 

Functional medicine is health-oriented, patient-centered, biochemical, individual, holistic, cost-effective, looking at underlying causes of disease, preventative, and high touch/high tech. Conversely, western medicine is disease-oriented, doctor-centered, cookie-cutter, specialized, expensive, symptom-based, procedure-driven, pharmaceutically driven, and high tech.

Communication is key because functional medicine seeks to elicit the behavioral and environmental causes of pathology and dysfunction. Functional medicine practitioners happily spend an hour or more on the first encounter even though it does not promote money-making procedures. Even though a good practitioner should discuss everything you want, doing your own research is a good idea. It can be difficult, but this post should help make it easier for you. To find a functional medicine practitioner near you, just type in a search.

Watching patients discover the true nature of human physiologic needs and become healthier is one of our ultimate joys. So if you are dissatisfied with the way things are, you can fight the system or leave it. Thankfully, functional medicine awaits you when you have had enough.