The Patient-Doctor Divide

A friend was telling me about her recent visit to a cardiologist, a very dissatisfying appointment. She had to wait an hour to see the cardiologist, and then when he came in, he spent 15 minutes making snap judgments. My friend is physically fit. She works out regularly, she has a healthy diet, and her measurements are mostly in the normal range; however, the medical establishment considers her overweight. All this cardiologist was seeing was the number on the scale. My friend was frustrated that he seemed to be ignoring both her and her previous test results and was instead wasting her time (and money) with unnecessary tests.

Another friend of mine who has always struggled with her weight has developed a severe case of anxiety (safety) when it comes to visits to the doctor. Her years of experience have taught her that all her doctor will see is her size. Her doctors always want to blame every physical ailment on her weight, and so they lecture her about how important it is to lose the extra pounds. It's not like she hasn't tried. She is constantly trying. Hearing the judgment in the voices of her doctors makes her feel guilt and shame (esteem). She feels helpless because her many efforts to lose weight have failed (autonomy). She feels frustrated because she visits her doctors for help, but she doesn't feel heard or understood (social). And, of course, the visits to the doctor are intended to receive treatment for physiological ailments. Yet she receives no relief for these because the only solution her doctors can suggest is a path she's already been down.

I do have friends and family who work in healthcare, so I can also see the situation from their perspectives. Going by the science and data, the more a person weighs, the higher their risk of a large number of health issues (cancer, diabetes, heart disease, stroke, osteoarthritis, kidney disease, and so on). If the patient feels like they're not being heard or understood, the doctor can also feel like they are not being heard (social) when day in and day out they are trying to convey the importance of specific health factors. They see many of the same patients regularly for the same issues, and many of those patients do nothing to change their lifestyles. Having their expertise go unheeded can also make the doctor feel helpless (autonomy) as well as feel like their expertise is being undervalued (esteem). Finally, the specialist who is an hour late and is only able to consult with the patient for fifteen minutes has probably not been gossiping with colleagues over the water cooler. Specialists are highly paid and highly in demand for a reason: it takes years of rigorous training and testing to reach their level of expertise, and because of this, very few people reach that level (low supply = high demand). The specialists I know work long hours to help as many people as they can, which can take both a physical (physiological) and mental (in terms of stress levels, safety) toll. 

Though I’m using weight as a sensitive spot for a patient in the above examples, there are lots of potential sources for anxiety: age, income, education, addiction, etc. Clearly there can be a laden divide between the patient and the doctor, and this divide has significance: the doctor has general expertise, but the patient has specific expertise—no one knows a person better than theirself. The two need to work together to solve a problem, but to be able to work together, the lines of communication have to be open. Sometimes it does take a mediator of sorts to help with that communication.

The good news is that the healthcare industry does understand the challenge, and they are working to address it. If you are struggling with your own healthcare because you feel like you aren't being heard by your doctor, I suggest reaching out to your healthcare provider to see if they have any suggestions. Many insurance companies and hospitals employ staff such as patient advocates, care managers, and wellness coaches to help bridge the divide between patients and doctors.

If that doesn't get you where you want to go, you can look for third party organizations that offer advocacy services. For example the Obesity Action Coalition advocates for patients through government policy and by offering a list of supportive healthcare providers. Another example is the Breast Cancer Resource Directory at the Patient Advocate Foundation for patients entering treatment for breast cancer.

Have you been on one end or the other of the patient-doctor communication divide? What did you do to overcome it?