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Why Doctor-Patient Relationship Can Be Strained continued...

And according to a report by the pharmaceutical firm Pfizer, many diseases, conditions, and lifestyles still carry a stigma in our society. Examples would be:

  • Mental illness
  • Sexually transmitted diseases
  • Sexual orientation
  • Sexual dysfunction
  • Bowel and bladder changes
  • Obesity
  • Diabetes
  • Domestic violence
  • Memory loss
  • Painkiller, recreational drug, or alcohol abuse

Added to this perceived stigma is a prevailing notion that people should be healthy or they are doing something "wrong." To be less than perfect can sometimes trigger discrimination or censure, which Pfizer termed "healthism," putting it on a par with racism or sexism. Some people feel even doctors can have a touch of healthism.

Patients may also be reluctant to talk about private parts, sex, or bodily functions. One patient tells the story of having a paralyzed bowel and telling someone why she was in the hospital. Her sister hissed, "Don't even say intestine!"

"You could be embarrassed," Hubbard says. "But anything you say will not surprise the doctor. It's best to get to the main point right away."

Make the Doctor-Patient Relationship Work for You

Your doctor is not a detective. Even the best diagnostician needs clues. "I have had patients who won't say much and even say, 'That's for you to find out,'" Hubbard says. "You have to be honest with me."

Being honest means:

  • Telling about all medications you are taking. One doctor said some patients do not consider birth control pills to be a medication; they are, as are all herbal and vitamin supplements. Be sure to list medications given by other doctors, even if they are painkillers that were prescribed by other physicians. If you must, dump all your pill bottles in a bag and bring it to the doctor's office.
  • Answer lifestyle questions honestly. Some doctors ask about sexual orientation; today that can be an issue if you are having unprotected sex (another thing to be honest about). Bill Clark, MD, president of the American Academy on Physician and Patient, tells WebMD he quizzes patients about alcohol use. "I use CAGE," he says. "That is an acronym for: Have you ever felt the need to CUT down? Does your drinking ANNOY others? Have you ever felt GUILTY about drinking? And do you ever need an EYE opener in the morning?"
  • Don't conceal symptoms. Some patients are reluctant to report "lost time" that might come from epileptic seizures, because it can mean confiscation of their driver's license. But the doctor needs to know this. Other symptoms that could signal serious diseases -- such as heart disease, diabetes, or mental illness -- are often downplayed.
  • Mention your personal situation even if it means taking more time. One of the most stigmatized diagnoses in the minds of patients is mental illness. Treatment is not covered under many health plans and it can prompt discrimination at work or lack of self-esteem. Marla Rowe Gorosh, MD, a family practitioner at Henry Ford Health Systems in Detroit, tells WebMD she had seen a patient 10 times over three years and had treated him for depression, without really knowing the cause. Then the patient finally mentioned some painful personal information about his wife's behavior, and some pieces started falling into place for her. "Sometimes, I realize I have been making incorrect assumptions," Gorosh says. Hubbard agrees. "There are lots of stress-related problems that can influence or cause physical or mental problems," he says.

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