In the past, patients who visited multiple doctors were seen as whiners who “doctor shopped” until they got the diagnosis they wanted or the prescriptions they set out to get.
These days, our culture encourages patients to find a doctor who understands their needs best, and to seek out treatment that best suits them, health experts say.
“What we noticed in the last 10 or 15 years, is the patients are now better at advocating for themselves. They are more critical of their options. They have the resources to make better-educated choices and, in turn, they know to make their preferences known when they seek medical help,” said Dr. Alan Christensen of the University of Iowa, who studies patient-provider interactions and health services.
Now, not only are physicians learning to be better listeners, they are also learning to translate what they hear into more personalized care for their patients, Christensen said. This is a shift from the old relationship, in which doctors took paternalistic roles and patients merely followed their directions.
The shift toward more equal ground in the relationship is bringing better medical care, studies have shown. And technologies that give patients more access to doctors and their own medical records are further opening the lines of communication.
However, communication skills aren’t all physicians need to deliver good care, and some worry that in all the doctor-switching, the benefits of long-term relationships between providers and patients are being lost.
Looking and listening
One hallmark of the change is that doctors now take more time to embrace their patients’ individual needs, Christensen said. “For example, something as simple as test results for cholesterol and lipid levels — it’s important to not only tell the patients the numbers, but also what that number means in the context of the patient’s overall health, specific habits and lifestyle changes.”
“This has the potential to make health care more effective,” he said.
For example, patients are better at keeping their prescriptions updated and their blood pressure in check if doctors tailor their manners to suit their patients’ expectations, according to a study Christensen published in the Journal of General Internal Medicine in 2010.
And if a doctor isn’t a good fit, patients are likely to move on.
Caitlin Getchell, an assistant at a nonprofit organization in Tulsa, Okla., said compatibility was an important trait she looked for when she switched her family practitioner recently.
“I felt the doctor I had been going to wasn’t listening to my concerns,” said Getchell, who is in her mid-20s.
“My new doctor not only treated me for what I came in for and answered my questions, but he also brought up some things that it hadn’t occurred to me to ask about,” she said.
Doctors and health care providers have started to modify their practices with an eye to improving communication.
Kaiser Permanente, one of the largest not-for-profit health care groups in the United States, uses a secure e-mail system to reach the more than 3 million patients in its network. With a few clicks, patients can access their electronic health records, see their test results, refill their prescriptions and e-mail questions to their doctors.
“Not only is this more convenient, this is more transparent, too, because all your medical history is there,” said Terhilda Garrido, vice president for health information technology transformation and analytics at Kaiser Permanente.
“You can talk to your doctor while you have all this information pulled up. So you can ask questions that are very specific to your medical history, and get answers and advice specific to your conditions,” Garrido told MyHealthNewsDaily.
Electronic communication has also changed the way patients are referred to specialists. For Kaiser Permanente patients, primary-care doctors act as a central hub, making it easier to suggest referrals and coordinate the treatments delivered by specialists.
The limits of technology
However, despite the improvements such technologies bring, no e-mails, Skype chats or Facebook messages can replace a doctor who is truly attentive to patients’ needs.
“Overall, I think the different ways of communication are great, but I don’t know if they change what you look for in a great doctor,” Getchell said. “I don’t mean to downplay how great the bells and whistles are. I definitely prefer getting appointment reminders via text, and I appreciate the information I get in the e-newsletters from my eye doctor.
“But for me, the ideal would be a doctor who listens and is available. I often end up at an urgent-care clinic if I’m sick or have to take off work for checkups,” she said.
Getchell is not alone in her sentiments. Effective communication, especially with a doctor who knows your medical history well, can strongly influence the quality of care you receive.
In fact, patients who had a consistent relationship with a single physician were healthier and more satisfied with their care than those who hopped between doctors, according to a review published in 2010 in the Journal of Evaluation in Clinical Practices.
And physicians agree. In a Consumer Reports survey released this month, 76 percent of primary-care physicians who responded said a long-term relationship with a primary-care physician is the most important thing a patient can do to get better medical care.
The future of doctor-patient relationships
Overall, researchers have an optimistic view of how doctor-patient interactions could evolve in the next decade. Some, like Christensen, believe better care comes when patients shop around for the physician who best suits their needs. Others, like Garrido, believe that greater transparency will help patients and doctors make better-informed decisions.
However, there are hurdles to such ideals becoming available to all patients. The cost to implement and maintain a secure electronic notification system may be prohibitive for smaller health care providers and clinics. And for doctors to know their patients well enough to provide personalized care, they might have to take time away from their clinical hours to have conversations with patients to better understand their preferences.
The current insurance system, which establishes a network of providers for patients to chose from, can also be a barrier.
“I do think it’s possible to shop around, and I like that we are now able to find reviews of doctors online. However, I’m still limited to the in-network providers. It doesn’t matter how good the doctor is if they aren’t in my network,” Getchell said.
Seeing an out-of-network doctor isn’t an option for her, Getchell said. And some lose access to a long-time doctor when their employment status changes, or their employer changes insurance companies.
“I can’t afford to waste money on doctor visits that could be paid in full simply because I like a doctor,” she said.
Ultimately, in order for patients to take advantage of the new resources and attitudes toward doctor-patient interactions, they’d need to be able to easily switch doctors and also be able to stay with a doctor they like even if their health plan changes. But for now, Getchell said, she is satisfied with her options.
“There are enough doctors out there that I believe it is possible to find someone covered by my insurance who also meets my standards.”
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