Without doubt, communication is crucial to good health care. When people
take an active role in their care, research shows they fare better -- in
satisfaction and in how well treatments work. A passive patient is less likely
to get well.
Yet patients often don't speak up for themselves, says Dr. Paul Haidet,
staff physician at the DeBakey VA Medical Center, in Houston.
In Nora Ephron's best-selling book, I Feel Bad About My Neck, she
laments the sorry state of her 60-something neck: "Our faces are lies and our
necks are the truth. You have to cut open a redwood tree to see how old it is,
but you wouldn't have to if it had a neck," she writes.
"Every so often I read a book about age, and whoever's writing it says it's
great to be old. It's great to be wise and sage and mellow; it's great to be at
the point where you understand just what matters in life. I...
Haidet learned this lesson first hand with a new patient complaining of a
cough. A 50-year-old Boston dockworker with no serious illness in his past, the
patient said the cough had been hanging on for three weeks. Haidet noted the
details, performed a physical exam, and diagnosed an upper respiratory tract
"The guy had a cold," Haidet tells WebMD. He recommended cough syrup
and was about to leave, but something gave him pause. The patient "just had
this weird look on his face," Haidet recalls.
Haidet learned that the man's best friend had recently died of lung cancer and
when his friend was diagnosed, he had a very similar cough. As a longtime
pack-a-day smoker, the patient was afraid his number was finally up.
The Ideal Doctor-Patient Relationship
Chest X-rays eventually showed the patient had no tumors, but Haidet was
astonished by the difference between what he thought the visit was about and
what the real reason was. He had assumed the man wanted him to treat his cold,
but he really wanted to be assured that he didn't have lung cancer.
Haidet, who now runs part of a program at Baylor College of Medicine that
helps people communicate with their doctors, feels sure that the patient
"would have kept going to doctors until somebody unlocked that story and
addressed the real issue for that visit."
The ideal doctor-patient relationship, says Haidet, is like a meeting of two
"experts." The doctor comes to the meeting with medical expertise.
"The patient is entering with contextual knowledge, what these symptoms
mean in the broader context of my life, and what kinds of therapies that
broader context is going to support," he says.
So, how do you manage an "expert" meeting of the minds with your