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

March 24, 2010— -- 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.

Last he said he wanted to screen me for prostate cancer. I had recently reported on the new guidelines for prostate cancer screening put out by the American Cancer Society. They recommended that doctors and patients have a conversation about risks and benefits of screening with all men when they hit age 50 and with higher risk men at an earlier age. The decision to screen should not be automatic but instead should come from weighing an individual's personal risk of developing prostate cancer as well as their perception of the benefits of early detection. I had done my research, explored my family history, and was ready for our conversation.

Well, having challenged him on aspirin and vitamins, I had run out of steam. He felt very strongly that screening was beneficial. I was unconvinced that in my case it was.

"Wouldn't you want to know if you had prostate cancer?" he said.

"I would if I also knew from the screening test whether it was a bad cancer."

As an epidemiologist, I knew that with no family history of prostate cancer, a positive test for me was most likely a false alarm.

He said he had a urology group he used that was very good with robotic surgery and had low complication rates. He had followed many men with PSA values above normal without operating initially.

I understood his approach and considered it reasonable, yet was unconvinced that, for me, I wanted the test.

He completed his thorough physical exam, ordered an electrocardiogram, and some blood work, including the PSA test for prostate cancer. I got dressed, thanked him for his time, and headed home. As I drove, I thought about this more. It's my body. If I can't express my wishes, how can I expect my patients to do the same? I liked this doctor and did not want to find another one. Better to risk offending him and taking a step towards having the type of relationship I believe everyone should have with their doctor.

After pulling into the driveway I took out my doctor's business card and called the office.

"Doctor's offices, may I help you?"

"Yes, please. I was just seen a few minutes ago. I would like to cancel a test."

For tips on how to help you develop an open relationship with your doctor, see "Are Doctors Recommending Too Many Tests?"

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"Do you have any tips on how to make it easier to communicate with your doctor?" Share your thoughts on the comment board!