Why Doctors Behave the Way They Do

Many doctors are heroes because they save lives every day. So, why are so many of us unhappy with our doctors? 

According to a recent study, 21% of patients were dissatisfied with the care they received from their doctors.

To make matters worse, health issues such as high blood pressure, high cholesterol, diabetes, and obesity are on the increase. 

This, in turn, creates a bigger workload for most doctors, who complain that they don't have enough time to provide the quality of care that most patients expect to receive. 

For example, a disease such as Type 2 diabetes is a very difficult disease for most doctors for several reasons. 

First of all, your doctor doesn't have the time to ask you a lot of questions about what your meal plan and exercise regimen. In most cases, your doctor is running behind schedule, so he/she needs to make a snap decision concerning what to do about your diabetes.

Doctors are trained to provide solutions in the form of prescription medications and, if necessary, surgery -- that's what your doctor and all the other doctors have been taught in medical school. 

So, we should not get upset with our doctor when he/she cannot provide a better alternative (non-drug) solution for your health problem.

Also, that doesn't mean you should totally ignore your doctor and stop seeing him/her. In many cases, it's simply poor communications.

In addition, there are certain things that Western Medicine does very well. So, it would behoove you to take advantage and reap the benefits of Western Medicine and its technology.

If you want to get more out of your appointments, there needs to be better communications. To help you with better communications, it is important for you to understand how your doctor thinks and how to use that to your advantage.

And, even though we may not enjoy our visits to the doctor, we know that it is a necessary practice if we want to be proactive in taking care of our health.

It seems that no matter our age, gender, or position, while we're waiting anxiously in the doctor's office, we feel like we're back in high school, waiting in the principals' office to find out what you did wrong.

Finally, your doctor shows up (usually late) and says something innocuous  like: "Well, how are we doing today?"

We're not sure what to say, so we usually say something just as innocuous, like: "I'm fine."

After reviewing your medical history and your most recent lab work, your doctor pulls out his little notepad, scribbles out a non-readable prescription, and hands it to you, saying something like: "This should take care of your problem. See my secretary on the way out." 

Or, your doctor may say something like: "We need to run some more tests. Please see the nurse on the way out."

You try to say something or ask a question, but, you're either ignored, interrupted or  your doctor says something like "Time's up." as he/she skates out of the room onto the next appointment.

And, that's it! You've just spent anywhere from $50 to $200, depending on the amount of lab-work, the scope of your exam, where you live, and whether or not you have insurance. For a 15-minute appointment, that works out to a nice hourly rate of $200 to $800!

And, more than likely, you're not happy with the appointment. But, who's fault is it that things didn't go the way you wanted? 

It's easy to blame it on the doctor, but, in most cases, it's our own fault for not getting prepared before the appointment. We try to "wing it", but winging it just never works.

Instead, you should do a little planning before the appointment, i.e. write down 1 or 2 questions that you want to ask, carry a little notepad with you -- that will show the nurse and the doctor that you're taking responsibility and accountability for your health. Refer to the previous blog post (Doctor Appointments & Tips) for more ideas about what to do before your next doctor's appointment.

We want to trust our doctors and believe they are superb at what they do. The alternative is too unnerving to consider. Yet the thriving medical malpractice industry proves that our doctors don't always deserve our devotion. 

Sometimes they disappoint us, endanger us, treat us like children, and ignore our input. Or do they? Maybe the problem is with us. Maybe we just don't know how to talk to them. 

Whoever is to blame for the miscommunication, both sides pay dearly in health and money: 70 percent of all medical malpractice suits are filed not because of technical negligence but because the patient misunderstood the doctor.

Medical schools have been paying more attention to this problem lately, and the new generation of doctors is supposedly trained to listen, be empathetic, and look beyond the most obvious diagnosis to see if a patient's problems might be more complex. But while doctors are trying to improve their bedside manner, reality is undermining them.

Doctors today have far less time to spend with patients than they did twenty years ago, mostly because of the paperwork demanded by HMOs and insurance companies and the patient load required to make ends meet. In the typical practice, a visit with the doctor lasts 7 to 15 minutes—and is interrupted within the first 27 seconds by a nurse or a telephone call.

And, if you’re diabetic with a bunch of blood glucose readings, you find that your doctor doesn’t have the time to really pay attention to your data and your health concerns. This can be a little disconcerting, since your doctor was the one who told you to collect the data in the first place!

Meanwhile, doctors who think they are improving their communication skills are often mistaken. One study asked physicians how much time they spent educating their patients. "Nine to ten minutes" was the most likely response. 

In reality, it was about one minute. And patients clearly need the education. Another study highlighted the sorry state of patients' "medical literacy": more than 40 percent of patients couldn't understand instructions that indicated they should take a certain medication on an empty stomach.

Even the most well-meaning doctors regularly fail their patients by overestimating their knowledge of medical terminology and rushing through the exam. Patients complain that doctors don't ask their opinion, don't explain the side effects of drugs, don't take an adequate medical history, don't warn them properly about the difficulty of recovery, don't take their pain seriously, and discourage questions—and that's just a short list of grievances.

Complaining is useless. Waiting for your doctor to change is futile. Your only choice when it comes to dealing with doctors is to change your own behavior in order to influence theirs.  Again, refer to the previous post for a list of specific things that you can do to get more out of your appointment.

Behind the Scenes: They're Not Gods, They're Overworked Humans with Godlike Powers

As a group, doctors don't inspire much sympathy, yet in order to get the best treatment you must be able to see things from their point of view. Like all of us, doctors have feelings and fears that influence their work.

First, consider your doctor's mission: to heal you. If he can do it, he is a success. If he cannot, he thinks he is a failure—and doctors hate to fail. You may feel powerless in his presence, but in fact his self-esteem depends on you. 

Will you heed his advice or ignore it? Will you refuse his treatment? Lie to him about your symptoms? Snub him for another doctor? 

Occasionally, even if you follow the doctor's instructions, you won't get well. His skills will fail you and so will the medications. This is a doctor's greatest fear and a source of constant anxiety – especially when it comes to a disease like diabetes.

Doctors assume that the medication is going to work. That's what they were taught in medical school. If the medication doesn't work, the first thing that the doctor thinks is that you didn't follow the instructions, not that there was a problem with the medication.

When the doctor looks at your lab work, he/she quickly surmises that you need a medication for something -- usually for high blood pressure, high cholesterol, or high blood glucose.

Although you brought your blood glucose readings data with you, your doctor doesn't have time to review your blood glucose readings. In this particular scenario, the diabetic patient has more data than the doctor! Doctors are not used to this! This makes them uncomfortable, so they tend to ignore your data -- because they've already determined what medication to put you on or whether to increase the dosage, or switch you to a new medication. 

And, because diet is so important to diabetics, this is also unnerving to most doctors. Why? Because most doctors know very little if anything about diets and nutrition. In medical school, most doctors end up taking at the most a 3-hour course in nutrition – a course that most of the doctors skip or ignore.

Doctors are schooled to diagnose illnesses and prescribe some kind of pharmaceutical treatment as quickly as possible. With most internists logging about 150,000 office visits in their careers, speed and accuracy are highly valued. Being right is important, but being fast is the mark of a real pro. 

In surveys, medical literature, and interviews, doctors repeatedly admit to diagnosing the typical patient within just 30 seconds of walking in the examining room. "It is subsequently quite easy to go on autopilot," writes Victoria Maizes, M.D., in American Family Physician. 

Instant diagnoses, followed by formulaic, half-interested questions, thus become their normal mode of operation. Maybe it's not the way Marcus Welby would have done it, but it effectively propels them through their overpacked days.

The doctor is primarily focused on your symptoms so that he can quickly map your symptoms to a specific prescription drug. 

As a result, most diabetic patients end up on at least 2-3 medications: a drug for the diabetes, i.e. metformin (Glucophage), glipizide, glucotrol; a drug for the high blood pressure, i.e. Lisinopril, hydrochlora-thalizide; and a drug for their high cholesterol, a statin such as Liptor, Zocor or Crestor.

Another more troubling aspect of doctors' training is the well-known desensitization that takes place in medical school and during a physician's internship. It is a grueling trial by fire as the student is thrust into a world of pain, suffering, and death with very little emotional support. Barbara M. Korsch, M.D., who has devoted much of her career to studying doctor-patient communication, wrote a book on the topic: The Intelligent Patient's Guide to the Doctor-Patient Relationship (Oxford University Press, 1997). 

In her book she explains that in medical school the emphasis is on anatomy, chemistry, and other hard sciences, with little or no attention paid to the human aspect of attending to the ill. "When third-year students have their first intense encounter with real patients, they are faced with sickness and death in very large doses." 

As the years of training continue, "students' inner conflicts with facing illness and death become more and more acute. Their role models, the attending physicians, often behave toward them (and their patients!) in ways that are not very human....One of the goals in the education of physicians is to 'professionalize' them, to toughen them up."

When the training is finally over, relatively few doctors emerge with their empathetic equipment intact. Korsch says that doctors "turn away from emotion. They are not trained to deal with feelings." This detachment is very hard to unlearn. 

It doesn't have anything to do with a doctor's talent, but it does affect the way he treats his patients and the success of his practice. On the one hand, doctors with lousy people skills have trouble keeping clients and attract more lawsuits; on the other, doctors who aren't emotionally tough are likely to burn out and become unable to function.

Today's physicians, then, are constantly grappling with opposing forces. They want to solve your problem but must do it quickly, which automatically increases the likelihood that they will make a mistake. They depend on your compliance but you can defy them at will, which undermines their chances of success. 

Theirs is a people-oriented profession, yet they learn few social skills and have much of their natural empathy squeezed out during medical school. They must operate within ever-shrinking time and money constraints, even as patients are becoming more proactive and demanding more attention. They are expected to take control but are constantly being second-guessed by insurance companies, HMOs, and the patients themselves.

The result is that doctors are under a lot of stress. The power, respect, and money that once compensated for the tensions of the job are eroding. They spend more on insurance and keep less for themselves than they once did. Some doctors are even forced to change specialties because they can't afford the malpractice insurance. 

These healers, who at one time held themselves above the fray of commerce, are now neck-deep in it—resentful, frustrated, and concerned about the level of care they are able to provide their patients. So when the doctor walks into the examining room and you're laid out on the table like a piece of pastry, remember: underneath the trappings of power, he too may feel anxious and vulnerable.

Patient, Know Thyself

Physicians constantly complain that patients don't share crucial information about their symptoms and lifestyle. This is ironic, since patients' number-one complaint is that doctors don't seek their opinion. It seems as if patients are forever waiting for the doctor to ask just the right questions, while doctors are waiting for their patients to go ahead and spit out the facts already. 

It is up to you to break the impasse and start speaking up in the doctor's office whether or not he asks you the right questions. In fact, speaking up is the single most powerful thing you can do for your health. About 70 percent of correct diagnoses depend solely on information the patient tells the doctor, according to an analysis done by the American Society of Internal Medicine.

Talking to Your Doctor

Once you understand the mind-set of doctors, you can choose behaviors that will put them at ease while you draw information out of them. The most important strategy is to keep your voice steady and calm. Doctors are afraid of emotion, so the less you show, the more comfortable they will feel. 

Barbara Korsch explains: "If you put drama in your voice, it will turn the doctor off. Be quantitative and objective instead of saying how you feel. This is unfortunate; doctors shouldn't be that way, but in my studies we've learned that they are." 

When you seem desperate or panicky, when your voice is trembling with anxiety, the doctor's first reaction will be to try to tone it down. "Your emotional reactions engage doctors less than describing what it is you're reacting to," says Korsch. 

In addition to using a neutral tone of voice, the following words and deeds will keep you in the doctor's good graces.

Use neutral words to describe feelings. Be concerned instead of scared. Be apprehensive instead of a nervous wreck. In everyday life we tend to exaggerate to get results, but with doctors you have to go to the opposite extreme. Even if you are in agony, try not to use those words. Instead say, "I have a lot of discomfort." 

Use specific words to describe symptoms. "I haven't slept a wink," doesn't tell a doctor much. Instead say, "I've been averaging only four hours of sleep a night, and I usually get seven. I've been waking up every hour or so, and it takes me at least 20 minutes to fall asleep again."  

Talk about the most important things first. Doctors are very time-sensitive and will (understandably) be annoyed if you wait until the end of your visit to bring up a problem that requires some time to address. 

Make your expectations clear. At the beginning of the visit, tell the doctor exactly why you are there and what you hope she can do for you.

Acknowledge the doctor's situation. If the office is jam-packed and everyone seems stressed out, let the doctor know you're on his side: "It must be hard for you today, so I'll try to be concise." 

Be clean. Personal hygiene does matter. If you smell bad, the doctor will want to get away from you, just as anyone else would.

Keep in mind that most doctors believe that patients have a lot of misunderstanding about medicine, because their information is based on what they've heard from a friend or read on the Internet. Most doctors are offended when patients start to "play doctor" and provide their own diagnosis.

So, when a patient arrives at the doctor's office armed with information, this can create unnecessary tension especially if the doctor pooh-poohs the information without any rational reason. 

In order for your doctor appointments to be more productive, read our next blog post, which discusses some steps that you can take before, during, and after the appointment. This information is also in Chapter 11 of the Death to Diabetes book.