I trained as a specialist Family Physician and one of our main focus points is on cultivating a healthy patient-doctor relationship. Believe it or not, this is a postgraduate phenomenon, and certainly very little emphasis is placed on bedside manner in the undergraduate Medical Degree.
In fact, medical students skills are grown in an acidic environment: we learn by seeing patients who are admitted in a hospital, patients who are already held captive in the system. In our South African case, patients are still very much in awe of doctors and their status. Patients do not feel they are in a position to say "no" to these students, and thus the hierarchy is established very early on. The training doctor assumes the position of power, knowledge and authority. The patient adopts the role of passive, meek, child who is told what to do. This is how our medical students learn to relate to people, their patients. It is no surprise that so few doctors are aware of or work at growing a relationship with their patients.
If you are a patient, there are some things you need to do and know in order to establish a good relationship with your doctor.
1)You, the patient, are the one who takes ultimate responsibility for your health. This means that you have to be your own advocate for your health. Ask questions, ask for resources and information about your condition and do not be intimidated by your doctor. He or she has trained for many years and has skills and knowledge to help you. But he will never ever know exactly what it feels like to live inside your skin.
2) You are the expert on your condition. You live with it every day, get up in the morning and go to bed at night, clothed in this condition like a robe. Your doctor cannot possibly know all the details and nuances of what it is like to live with HIV. This means that your doctor may not always have an explanation for every ache or pain, and may also make mistakes. Doctors are human and therefore fallible.
3)Doctors take different shapes and forms. Some may be trained in homeopathy, some in Ayurvedic medicine, some in traditional medicine, and some in western medicine. It is your right to choose the type of healthcare that you wish to receive, but it is also your responsibility to ensure that you are informed about your choice, Do some research about the doctor you are seeing and his/her skills, and ask questions about their management of HIV. A doctor who is comfortable with his knowledge, and who is sound in his practice should not angered at questions. Anger is a defensive response that usually conceals selfdoubt or weakness.
4)You and your doctor are a team, not a parent and child. You should be able to establish a relationship where there is mutual respect, acceptance of responsibility (you accept the need to adhere to your chosen treatment plan, the doctor is responsible to provide you with sound, evidence based advice shown to be effective) and a trusting relationship (you need to feel secure that you can discuss any confidential or difficult matter with your doctor, and she needs to offer the safe space to allow you to open up).
5) Be assertive. If you are not happy with your doctor's handling of matters, then you are quite entitled to seek a second opinion. At best, it will confirm that your doctor is correct and trustworthy, at worst, it will give you a differing opinion which will need to be considered. If you do not agree with a plan of management, then tell your doctor. Remember, her agenda is to get you better, treat your illness, and to do this with minimal problem within the consultation time. Your agenda may be different: you may want her to explain things or just to be listened to, you may need reassurance or have other symptoms to be treated.
The goal with your relationship should be this: you should aim to remember his advice and to forget what he looks like. I want to remain in the background of my patients lives - if I am in the foreground, then it is an indication that the patients illness has taken centre stage and is consuming them. There may be times of illness where this is unavoidable. But, there will be times (and hopefully these will triumph) where you are well, living your life, and even forget that you are HIV positive. You keep your six monthly appointments with your doctor, but in between you can forget about her/him and live a healthy fulfilled life. That is the kind of relationship I aspire to with my patients, because the more invisible I am in their life, the better it is for them.
In fact, medical students skills are grown in an acidic environment: we learn by seeing patients who are admitted in a hospital, patients who are already held captive in the system. In our South African case, patients are still very much in awe of doctors and their status. Patients do not feel they are in a position to say "no" to these students, and thus the hierarchy is established very early on. The training doctor assumes the position of power, knowledge and authority. The patient adopts the role of passive, meek, child who is told what to do. This is how our medical students learn to relate to people, their patients. It is no surprise that so few doctors are aware of or work at growing a relationship with their patients.
If you are a patient, there are some things you need to do and know in order to establish a good relationship with your doctor.
1)You, the patient, are the one who takes ultimate responsibility for your health. This means that you have to be your own advocate for your health. Ask questions, ask for resources and information about your condition and do not be intimidated by your doctor. He or she has trained for many years and has skills and knowledge to help you. But he will never ever know exactly what it feels like to live inside your skin.
2) You are the expert on your condition. You live with it every day, get up in the morning and go to bed at night, clothed in this condition like a robe. Your doctor cannot possibly know all the details and nuances of what it is like to live with HIV. This means that your doctor may not always have an explanation for every ache or pain, and may also make mistakes. Doctors are human and therefore fallible.
3)Doctors take different shapes and forms. Some may be trained in homeopathy, some in Ayurvedic medicine, some in traditional medicine, and some in western medicine. It is your right to choose the type of healthcare that you wish to receive, but it is also your responsibility to ensure that you are informed about your choice, Do some research about the doctor you are seeing and his/her skills, and ask questions about their management of HIV. A doctor who is comfortable with his knowledge, and who is sound in his practice should not angered at questions. Anger is a defensive response that usually conceals selfdoubt or weakness.
4)You and your doctor are a team, not a parent and child. You should be able to establish a relationship where there is mutual respect, acceptance of responsibility (you accept the need to adhere to your chosen treatment plan, the doctor is responsible to provide you with sound, evidence based advice shown to be effective) and a trusting relationship (you need to feel secure that you can discuss any confidential or difficult matter with your doctor, and she needs to offer the safe space to allow you to open up).
5) Be assertive. If you are not happy with your doctor's handling of matters, then you are quite entitled to seek a second opinion. At best, it will confirm that your doctor is correct and trustworthy, at worst, it will give you a differing opinion which will need to be considered. If you do not agree with a plan of management, then tell your doctor. Remember, her agenda is to get you better, treat your illness, and to do this with minimal problem within the consultation time. Your agenda may be different: you may want her to explain things or just to be listened to, you may need reassurance or have other symptoms to be treated.
The goal with your relationship should be this: you should aim to remember his advice and to forget what he looks like. I want to remain in the background of my patients lives - if I am in the foreground, then it is an indication that the patients illness has taken centre stage and is consuming them. There may be times of illness where this is unavoidable. But, there will be times (and hopefully these will triumph) where you are well, living your life, and even forget that you are HIV positive. You keep your six monthly appointments with your doctor, but in between you can forget about her/him and live a healthy fulfilled life. That is the kind of relationship I aspire to with my patients, because the more invisible I am in their life, the better it is for them.
No comments:
Post a Comment
Have something to say? Speak out here