When patients are unengaged bystanders, their health suffers as a result. A recent survey from the AARP Public Policy Institute on the care of chronic diseases makes this clear. Of those who were less engaged, 36 percent experienced more medical errors — compared with 19 percent of those who were highly engaged.
Will Carpenter, a 57-year-old retired ship captain from Cookeville, Tenn., was determined to handle his surgery for renal cell carcinoma with the toughness he learned in 33 years in the U.S. Merchant Marine.
When he met with the doctor, Carpenter didn’t start with, "Am I going to die?" but he brought up more immediate concerns. "Not only did I ask the doctor if she had washed her hands, I also questioned her about the education, training and talent of the colleagues who would be assisting her," he says.
Many patients find it hard to speak up if doctors seem dismissive or unresponsive, even if they appear to be open to communication.
Medical Bridges Rackner says many people were brought up on "old medical manners" — that is, to be "good" patients. "Being polite was more important in the doctor’s office than in church," she says. Shulkin thinks that mindset is changing. "The days of ‘doctor knows best’ are waning, and the relationship is more about interaction," he says.
Communication is a two-way street
While patients need to express concerns and ask questions, doctors need to practice what Moira Stewart, M.D., director of the Center for Studies in Family Medicine at the University of Western Ontario, refers to as "patient-centered communication" — that is, pay attention not only to the condition but also to the patient's experience of the condition. Her research shows that when this type of exchange takes place, the patient has fewer diagnostic tests and referrals and improved health.
A "cascade of consequences" occurs when communication breaks down, Stewart says. For one thing, recovery is slower. "Patients with an acute condition should get better in six weeks — but they don't," she says. They are less likely to follow their medication instructions and are more likely to undergo unnecessary tests and to be readmitted to the hospital.