Does the thought of talking to your parent's doctor make your heart race and your palms sweat?
Maybe it's the pristine white coats, or the years of schooling that we know are crammed into their brains. Whatever this x-factor of intimidation is, research has shown that people find doctors intimidating.
A recently published study has concluded that, despite efforts to encourage shared decision-making between doctors and their patients, a good portion of people continue to view their relationship with their physician as one between a subordinate and a superior, rather than as a partnership.
After conducting a series of focus groups in the San Francisco area, researchers found that, even though most patients said they desired an honest dialogue with their doctor, many didn't feel comfortable actually having that conversation once they got into the exam room.
When asked about why they were hesitant to talk openly with their doctor, some participants said they felt they needed to conform to the traditional role of the compliant patient, while others felt that their physician was too "authoritarian" to be accessible. Some participants even expressed the fear that being labeled a "difficult" patient might result in a doctor punishing them by doling out substandard care.
While this study was conducted on the patients themselves, the findings coincide with the common caregiver concern of how their interactions with their loved one's doctor might be perceived and how that could affect the care their loved one receives.
These findings are of no surprise to Kevin B. Jones, M.D., surgeon and researcher at the Huntsman Cancer Institute, who was not involved in the study. "Most patients don't want to annoy a physician and get abandoned, so they are afraid to ask questions," he says.
Indeed, when it comes to doctors, Jones says, "A person should be more afraid of not speaking to them. They should be more concerned about the things they are not learning, the things that are not being explained to them."
For caregivers, obtaining sound knowledge about a family member's disease is essential. Having an honest dialogue with a senior's doctor can help you gain valuable insight into your loved one's condition, thereby enabling you to provide better care for them. You can learn what challenges a given disease or treatment plan may present, and what signs and symptoms to watch out for.
As the author of the book, "What Doctors Cannot Tell You: clarity, confidence and uncertainty in medicine," Jones is an expert on the barriers that stand in the way of effective doctor-patient dialogue.
The confidence conundrum
Especially when it comes to communicating with baby boomers and those over the age of 60, Jones feels that the traditional views of physicians as all-knowing may be doing more harm than good.
"Having a sense of respect for doctors isn't a ‘bad' thing—but it can be a problem," Jones admits.
According to the San Francisco study, even financial security and higher education don't seem to successfully inoculate a person against apprehension and a sense of unworthiness when it comes to dialoging with their doctor. Every person participating in the experiment was 40 years old or older, a good portion had completed graduate school, and 40 percent reported hauling in at least a six-figure annual salary. Yet many still said they felt as though they needed to defer to the doctor's opinion, whether they agreed with it or not.
But, having confidence in a doctor isn't a bad thing—in fact, it's an essential part of the treatment process.
If you don't feel like a doctor knows what they're doing when it comes to your loved one's health, how likely is it that you or your parent will listen to that physician's recommendations, or follow through with their suggested course of therapy?
Jones' solution to this dilemma lies in re-thinking the traditional doctor-patient paradigm.
A physician is simply someone who has more experience with a certain category of knowledge than the average person does—much like how a teacher knows more about the subjects they teach than their students do.
Would you hesitate to ask a teacher to help you understand a difficult concept?
Medicine: it can't cure everything
Jones adds that another thing that gets in the way of doctor-patient dialogues is that people often have misdirected—sometimes blind—faith in medicine's ability, as a discipline, to cure what ails their elderly parents.
In truth, not every medical problem has a solution. This is something that doctors know, but may be difficult for their patients and caregivers to recognize or accept.
"The challenge is that what medicine knows, it does not know with much certainty," Jones says.
For doctors, it can be tricky to toe the line between making their patients feel comfortable and confident, while not unintentionally giving a person the false hope that a diagnosis is definitely correct, or that a particular method of treatment always works.
When doctors and patients are resistant to open communication, that's when serious mistakes get made, according to Jones. "We [doctors] are human. Our knowledge is about human biology, which is widely variable," he admits, "If we're going to be honest about that, it's going to take a dialogue."
Talking to the man (or woman), not the myth
When it comes to communicating with a doctor, it's not about whether or not you should ask a question—you should—it's more about how you ask that question:
- Keep it friendly and open-ended: Jones suggests trying to make your queries open-ended, and non-adversarial. "It's about asking in a way that a good student might ask a teacher. You're basically saying to the doctor, ‘Help me understand what you're thinking.'"
- One question at a time: Jones recommends trying to limit yourself to a single inquiry that will hopefully spark a short dialogue with the doctor. For example, if you've gotten all the information about the treatment plan the doctor suggests, and you're still not totally comfortable with it, you may respond with something like, "What other options did you think about?" You can definitely ask a few follow-up questions, but remember that keeping the discussion on topic will allow you to obtain the most helpful information in the quickest amount of time possible.
- Don't tolerate a timekeeper: As for the doctor's time, while certainly limited and valuable, Jones says you should be wary of any physician who won't take a few minutes to talk to you and your loved one. According to him, "The concept that doctors don't have time is a fabricated concept. They're busy but, doctors have the same 24 hours a day that everyone else does."
- Internet savvy: Jones says you can feel free to bring in information you found on the Internet, if you wish. Just remember that some Internet-based medical materials are actually advertisements in disguise. Tell the doctor what you learned and then ask, "What do you think about this information?"
It's true that talking to your loved one's doctor may never be a truly ‘comfortable' experience, particularly when an older adult is faced with a complicated health concern. But, as Jones says, it's important for caregivers to, "invite the physician down from the pedestal."