Saturday, May 10, 2014

Balancing Expectations of Providers and Patients: Part I Can We Agree to Some Common Beliefs?

Recently, there was an intense discussion on a friend’s Facebook page about medical expectations. Providers and patients weighed in with both sides expressed very strong feelings and within their respective groups, voicing significant differences.

 This month several doctors have written about their despair over their profession: How Being a Doctor Became the Most Miserable Profession  and A Doctor’s Declaration of Independence. In addition, I came across a blog post Why Physicians Commit Suicide. The comments section was frightening. I chose the following example because it reflects common concerns and frustrations :“I’m in my first year of practice outside of residency and I can’t begin to tell you how often I think of death. Not because I hate my life — I have a wonderful husband and family. But the pressures of daily life as a doctor are overwhelming. I work constantly! Even on my days off, I’m working. When I take a day off, I pay for it later by double the amount of work waiting for me. I have patients yelling at me when all I wanted to do was help. They try to fool me and manipulate me. Insurance companies deny my patients help, leaving me with no resources to help. My boss is a douche — unethical and dangerous. I want to build a relationship and do what’s right for my patients — but the company pushes me to see more and more patients in less and less time. I cry at work, I cry myself to sleep sometimes. I don’t feel depressed, and I know my life has value, but sometimes the thought of suicide is just to escape the pressure of the profession. It’s not like I can realistically give up the job, my calling. I’m neck deep in debt and will never be able to pay it back if I leave the profession.”

On the flip side I hear from patients who are frustrated that their provider isn’t listening to them, doesn’t seem to respect their opinion about their situation, rushes them through visits, and maybe worst of all, they have difficulty reaching them, even if it’s an emergency. Some are dealing with medical bills and debt brought about by tests and treatments that they view as unnecessary. Others just do without medications, supplies and recommended office visits simply because they can’t afford it.

Add to this, the media touts a new treatment and at the same time, talks about the recent medical research that no longer supports current medical practices. Television spots, as well as full page ads in print media, constantly alert the public to their right to legal action if they had side effects from a particular drug or had a surgical procedure. Rounding it out is the deluge of information available to patient and provider alike thanks to the Internet. 

When doctors have one of the highest suicide rates in the country and patients are frustrated by their provider, something is very wrong. Where to begin? 

We’re spiraling out of control on both sides of the aisle and we need to start finding ways to stop, get a better handle on the situation and ultimately steer a new course in health care. One way to start is by identifying some basic assumptions that providers and patients can agree to. Below is a list to consider:

• We’re all mortal. Death is not a failure. It is part of the life process.

•  There is no “cure” for life. Rather the focus is healing and living a life of well-being.

• How to heal is up to the patient. Providers can be extremely knowledgeable, helpful and supportive in the process but it is the individual, or their designee’s, responsibly to make the choices. Providers must recognize that the patient has to live with the decision they make, which is why it’s their choice in the first place. Patients need to understand that the provider is advocating for what they truly believe is in your best interest. They want you to be healthy.

• Providers spend many years in school and continuing education learning to assist someone in healing. They appreciate it when patients recognized this. Patients have lived a life time in their body. Consequently, sometimes they do have a better idea of what will work for them and sometimes they don’t. Frustrating isn’t it?

• Healing involves the mind, body and spirit.

• There isn’t a pill, effective treatment or quick fix for everything. It is unrealistic to expect that. Often the best “medicine” can be found in how we eat, exercise, manage our stress and live our daily lives.

• Depending on finances, side effects and other factors, choices around treatments, tests etc. need to be carefully considered. Not every treatment/test works for every patient and every patient can’t afford every treatment/test. 

• We are responsible for the consequences of our actions and need to take responsibility accordingly.

• Even if we all made the right choices (exercise, organic fruits & vegetables, don’t do drugs, etc.) stuff happens and medical care is needed.

• Health insurance does not equal good health.

• Providers are people who cannot and should not be expected to act in that capacity 24/7/365 (24 hours a day, 7 days a week, 365 days a year). They need vacations, their privacy, time to enjoy family and friends, and to recognize that seeing too much pain and suffering and not enough joy is unhealthy. They also need to be paid for their time and expertise.

• Everyone makes mistakes including patients and providers. No one gets it right all the time. That said, both groups can help reduce mistakes by being honest, listening, and adhering to accepted standards of care.

• Medications, treatments and even tests can and do have side effects.

• Medicine is an art form. Instead of being shocked that medical research can not be replicated and that many of the treatments recommended today will be found to be useless or even worse weeks, months or years from now, choices and decisions for care need to be based on experience, the understanding of our body and on the most reliable research possible.

• The more litigious are society, the higher the cost of care and the more providers are pushed into “defensive medicine.”

• It’s a provider patient relationship, with an emphasis on relationship. Sometimes it works and sometimes it’s not a good match. Both parties have the responsibility to recognize that it doesn’t work and make changes. If it’s not possible to change providers, use third parties, such as an advocate, to help where possible.

• No one has all the answers. Patients and providers don’t always listen to one another. Providers don’t know everything and no one wants to think this is the way things are.  

• Patents and providers both deserve to be treated with respect and honesty, recognizing that neither is the enemy.

So what would you add or change to this list?

There are providers who are trying to work on this. One is Lissa Rankin, MD. You might find her 12Ways You Can Help Heal Health Care to be of interest. 

Further Reading

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