Dr. Besser's Notebook: Creating a Doctor-Patient Partnership

Dr. Besser's Notebook is a regular column that examines public health issues across the nation.

Congress passed health care reform legislation that will eventually increase the number of people with access to basic medical care. The value of this care increases dramatically if patients are able to develop an open relationship with their doctors. Talking about your body isn't easy -- and for many it is nearly impossible.

Ten years ago I was working at the Centers for Disease Control and Prevention on a campaign to promote the appropriate use of antibiotics. Millions of courses of antibiotics are prescribed for colds and flus, viral infections for which antibiotics just don't work. We were holding focus groups with young adults to see what they knew and how we might effectively develop an ad campaign.

I sat beyond a one-way mirror observing the process. "Do antibiotics work for bacteria, viruses, or both?" The facilitator asked.

"Viruses."

"Bacteria."

"I have no clue."

The group was pretty well split.

"Well, they only work against bacteria," she explained.

"What!" an irate participant exclaimed. "I saw my doctor last week. He said I had a chest cold from a bad virus and prescribed antibiotics. I'm really annoyed. "

"Are you going to say anything to your doctor?" she asked him.

"Oh no. ... I'd never do that. He's my doctor. I'm going to look for a new doctor."

And that is the crux of the issue. Rather than challenging his doctor, he would rather go through the hassles of looking for a new provider.

There are data that show the importance of having a regular provider: reduced hospitalizations, better screening, increased satisfaction. So frequently we hear ads on television which say, "Talk to your doctor." But how often do people do that?

There is a power relationship between doctors and patients that can be challenging to overcome. Asking tough questions isn't easy -- even though it's your body.

Yesterday I had my annual physical exam, and I learned how challenging it can be. I'm not your average patient: I'm a doctor, researcher, and former medical school teacher. I talk about health every day on ABC News and read about it constantly. Yet, talking openly and honestly with my own doctor wasn't easy.

Not that he wasn't open to a conversation; he was. But as I sat on one side of his big desk and he on the other, I felt a bit inhibited. He asked if I was taking a baby aspirin. When I said no, he asked why not? I told him that I didn't feel it was indicated given my family history and lack of risk factors for heart disease. I had read the literature and believed that my risk of having gastrointestinal bleeding from the aspirin itself was greater than any benefit I would be afforded.

He could see my perspective but still thought it would be a good idea. I kind of felt like I was letting him down a little bit. He then asked if I took a multivitamin. Again I said no. I eat incredibly well. My wife is a food writer and we eat all of our food groups regularly. Again, he thought the vitamin couldn't hurt but wasn't necessary.

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