Health Care Reform:

Getting the Care You Need

The Well-Informed Patient continued...

"Patients want to play an active role [in managing their health] -- they now say, 'You are not doing anything to my body without me understanding it and going along with it,'" Suchman says. "As patients are changing their role, the question is how that affects the role of [healthcare] professionals. The current model of medical professionalism sees a person who becomes a patient as helpless, dependent, and passive. Can physicians shift out of that role to lift patients up rather than hold them in a passive position?

"Well, I find this new role more satisfying," says Suchman. "I get a partner instead of a person on my shoulders. But there has to be a change in expectations [on the part of the patient]. If the patient is going to think I am an idiot for not knowing something, I am not going to want him to look on the Internet. And I think we both lose in that case."

Neuwirth says that the patient and the doctor each have to take responsibility for changing the nature of their relationship -- even if the current state of healthcare makes that difficult.

"The system is fixed against improving the doctor-patient relationship, and people have to be creative to change that," he says. "I think patients have the ability to stand up and speak for themselves. They can say 'I want' a certain amount of the time: 'I want you to listen to me, I want to ask you a certain number of questions. We can visit more frequently, or do it by phone, but I really want this kind of interaction with you.' And there are people who do that."

Power to the Patient!

Levinson notes that patients come in to their doctors' offices with expectations and beliefs about what will happen. For her, the issue is a practical one: how will the doctor and patient negotiate differences of opinion?

"One of the strategies I really have enjoyed using is asking the patient about the invisible third person in the room," she says. "That is the person who before the patient came to the doctor said to them, 'Remember to ask about such-and-such.' I like to ask patients, 'who do you talk to about your healthcare.' And they say, 'Well, I talk to my Aunt Marge, she's a nurse.' And so I say, 'What do you think Aunt Marge might think about this therapy we are talking about?' That sounds convoluted, but it is a lot easier to disagree with the doctor through an invisible third person and challenge what the doctor is telling you by saying your Aunt Marge might not agree with the treatment plan."

Suchman advises patients to think hard not only about what they want to get from their relationships with their doctors, but what they are willing to contribute.