Generally speaking, the communication between a doctor and patient inherently represents a power imbalance, where the physician has more knowledge and control, as they act as a gatekeeper for both diagnoses and treatments. Further, the amount of time available for appointments is often limited, placing additional pressure on the patient to make sure their chief concerns are known, understood, and addressed.
So what can a chronic illness patient do to enhance the doctor-patient relationship? The answer can be found in the book, Crucial Conversations: Tools for Talking when Stakes are High, Second Edition. A crucial conversation, broadly defined, is a discussion between two or more people when a) the stakes are high; b) opinions differ; and c) emotions run strong.
Needless to say, many conversations between a chronic illness patient and their doctor constitute crucial conversations. The authors state that when crucial conversations occur, we often either avoid them, handle them poorly, or handle them well. In fact, two maladaptive strategies that we often employ when we feel “unsafe” in a conversation is to either to be silent – withholding meaning from the dialogue or free flowing of ideas – or violent – forcing meaning upon the dialogue. An effective communicator who contributes to and enhances the dialogue, on the other hand, gets all the relevant information out into the open and they willingly and capably share their views, even when their ideas are controversial or unpopular.
The effective communicator is one who can stay in dialogue – the free flowing of ideas – when angry, scared, or hurt. In addition to being knowledgeable about chronic illness and prepared, which is easier said than done because invisible chronic illnesses can be difficult to understand even for the patient, communication is critical. The key points that an effective communicator follows in a doctor-patient relationship are:
- Develop a rapport that establishes an atmosphere of mutual respect. Sharing a brief, benign joke or telling a personal anecdote can enhance the doctor-patient relationship at the start. I personally have found that the doctors I am able to laugh with or make small talk with are more willing to listen to me and prescribe treatments that might benefit me. For example, my general practitioner will usually ask me how my job is going, showed me a picture of his family, and once told me a story about his fiasco with a student loan company. When it comes to treatment choices, he will prescribe me a medication (within reason) if I make a phone call to his office, as we have established mutual respect and he trusts me.
- Stay focused on what you really want. In the case of any type of chronic illness, it is likely that you are seeking relief of a symptom or symptoms. Because time is limited, it might be helpful to write a list of key symptoms you hope can be addressed through the physician as well as specific questions that you want the physician to answer. Of course, it is important to keep in mind that your physician may not be able to address all your symptoms, and you may in fact need an additional specialist to address certain problems, such as going to a sleep specialist for a sleep disturbance. In any case, this will help you stay focused on your number one goal.
- Have an open conversation about treatment choices. Nothing stymies discussion like fear. However, if you are able to have (and even foster) an attitude of mutual respect in the doctor-patient relationship without fear, you should be able to engage in a dialogue – and make shared decisions about – tests, medicines, and surgeries, and be able to openly ask questions about the risks and benefits of each. If you are confused about what your doctor just stated, make sure to get them to clarify what they meant.
- If you have substantial reservations about your relationship with your doctor or the treatments offered, however, it might be wise to forego the recommendation and seek a second opinion with a different specialist. In this instance, you might feel that your doctor is not listening to you, you are not connecting with your doctor, your doctor is minimizing your concerns, or you sense irreconcilable differences with your doctor. After all, a positive rapport between yourself and your doctor is essential in facilitating the outcome you seek.
- Some additional considerations, according to the authors, include:
- Speak persuasively, but not abrasively. It is helpful not to overstate concerns, but rather to state concerns briefly, clearly, and perhaps even to share your story tentatively and humbly. A doctor will be much more inclined to assist you if they perceive you are humble and sincere, while they might be less inclined to help or invest in your health if they see you as overly self-righteous, have an axe to grind, an overly strong viewpoint, and are disrespectful toward them or other lines of thought.
- Remember, there is an intermediate step between what others do and how we feel; in this sense, the authors argue that we cannot let our emotions control us, but rather we need to master our emotions and, in turn, master crucial conversations. This step involves adding meaning, motive, and judgment to the dialogue, and the fact this step exists explains why when faced with the same circumstance, ten people may have ten different emotional responses.
- Be willing to listen to his or her ideas. Even if the doctor may not be knowledgeable on your condition, there may be an area of his or her expertise and recommendations that could help your symptom(s). I can assure you that I have gained from insights, expertise, and sometimes treatments of doctors who knew very little about some of my specific health conditions.
Some of the aforementioned ideas to enhancing doctor-patient relationships are really just the tip of the iceberg, and you are encouraged to read Crucial Conversations for yourself to learn more. The authors contend these communication skills can readily be learned and applied with practice. I have enjoyed reading this book, and I am hoping to apply some of the techniques to not only my relationships with healthcare providers, but also to my family life and my work life.