As medical students, our textbooks tell us that 

“The effective physician needs to recognize that the person they are seeing is much more than just the presenting complaint and proceed with the encounter with an open mind without preconceived notions. A positive encounter occurs when the physician partners with the patient to find the most effective approach to improve the patient’s health”  (Foundations of Osteopathic Medicine, 4th edition). 

But as we moved from the classroom to the clinic, most of us have discovered that the nature of the relationship between patients and their doctors is heavily influenced by the demands of insurance based, for-profit medicine systems that force us to rush through encounters without taking the time to know or properly care for our patients. It is becoming more and more common in medicine for appointments to be 5 to 10 minutes long for most patients, and many relate feeling lost or unheard in our current medical culture. With so little time to see our patients, doctors are seen as prescribers instead of caregivers or healers. 

As technology advances, medication lists lengthen, telehealth encounters become more frequent, patients ask fewer and fewer questions about their health, and we as a society become more and more unwell.

But let’s take a moment to examine the doctor patient relationship as it was intended. 

The Role of the Physician:

1. Listen:

According to the NIH’s National Library of Medicine, on average, a patient is interrupted by their physician after only 11 seconds, with some physicians interrupting after as few as 3 seconds. This is a staggering statistic that really highlights the state of our current Healthcare culture. Patients who advocate for themselves and ask not to be interrupted are often labeled as “difficult” or “demanding” and in extreme cases may be fired from practices for wanting to be heard instead of managed. I have found in my practice that patients (most patients) want to get better, and even more than that, I find that they will often tell us exactly what is wrong if we  just take the time to listen. 

One of the most common phrases that I hear from patients after they understand that I am listening to them is “This may sound weird” or “Everyone has told me I’m crazy but…” and my immediate response is “There’s not much you can say that will sound crazy to me” or “I’ve heard a lot of crazy, and you don’t seem crazy” because the truth is, their feelings are valid and they really want to tell you, but they’ve been ignored or blown off by someone else and they are reluctant to experience that again. 

A physician’s number one job is to listen to their patients. Not just what they say out loud, but what they are afraid to say. Osteopathic physicians listen to the words being said, but are also trained to listen to the body- the tension of the muscles, the pull of the connective tissue, the way the nerves communicate with the body. My hands are often more important than my ears when it comes to finding out where the root of the problem lies. 

2. Educate:

I have a coffee mug that was given to me by a student that says “Don’t confuse your Google search with my medical degree”, and while this is humorous and makes me giggle, there is a lot of truth behind it. In the age of information, the whole of medical research and myth is available at our fingertips. The trouble is deciphering what is relevant from what is “fake news”. 

As physicians we should strive to educate our patients about their bodies, their health, and their health care. My treatment room is perpetually furnished with an atlas of anatomy and I use it often to explain what is happening to my patients and why they are feeling the way they are. I also very frequently look things up while in a patient encounter to better explain and educate my patients about everything from anatomy to blood tests to skin rashes and more. 

I find that patients who understand the basics of what is happening to them are more willing to listen and make changes to help them live more fulfilling lives. After the first visit, my patients come back with questions to ask because they know I will take the time to answer them and make sure they understand. 

3. Engage:

I often tell my patients that as they recover or become more functional, that I did nothing and their newfound health is all of their own making, which is true. My job as a physician is not to “make you better”, my job is to engage you with your health and empower you with tools to live your best life. I am mostly a cheerleader on the sidelines encouraging you and reminding you how far you’ve come on your journey to health. 

Handing a patient a handout on how to exercise for low back pain is a lot different than sitting beside them on the treatment table and going through each exercise and having them demonstrate it before they leave the office. 

I find that the combination of education and engagement significantly boosts my patient compliance levels because my patients know what is wrong and why I am asking them to do their homework. 

The Role of the Patient:

1. Listen:

Quid pro quo, my friend. As a physician I will take the time to listen to you, but you also have to listen to me. Basic rules of human interaction tell us that when we do not feel listened to, we tend not to listen in return. 

If we work together to listen to each other, the encounter and our relationship is so much better. 

Your homework as a patient is also to listen to your own body. See how things change, or don’t, when you initiate changes in your routine. 

-Keep a symptom journal- this could include things like what you are eating, how your diet is changing, how you are physically feeling, or how you are feeling emotionally. Bring this to your appointment to see if we can find some triggering foods or activities that are making your symptoms worse. 

-If you don’t want it to be written down, you can also keep a note pad in your phone, or there are several journaling apps you can use for this. A video log also works. 

-Practice mindfulness with a daily body scan- you can do this any time of day, but most people find it easiest to do consistently if it’s done at the same time every day. Start by lying or sitting comfortably. Then start at your toes and bring your attention to how you are feeling. Then move your attention slowly up the body focusing on each part individually to see if you can listen to what’s going on and track any changes over time. 

2. Advocate:

Patients who are labeled as “difficult” or “demanding” in some practices are really just trying to advocate for themselves. In these situations, I find that most of these patients are frustrated because they are not being heard. Our natural instinct when we feel ignored is to get louder until someone sees us, and if that doesn’t work, we will shut down. 

When I was in Africa, I saw the way the health care providers treated the patients. Everything that happened was done TO them, not for them or with their consent. Physicians told patients what to do instead of discussing options and coming to an agreement on a plan that aligns with the patients preferences. In that setting, I also saw fear and reluctance to seek care. 

When I saw patients in the hospital that had waited too long to seek care and I asked them why they had waited, they typically had a story of how they had been mistreated by the health care system and it had made them reluctant to repeat the experience. 

When you have a physician who is willing to listen to you, it is a lot easier to advocate for yourself. However, if you find yourself in a situation where your current provider is not meeting your needs, it may be time to find something new that aligns with your goals and preferences. (See below- Doctor Shopping)

3. Make Changes:

I don’t make you better, you make you better. 

I never ask anyone to completely overhaul any aspect of their lives long term. That’s not sustainable. The best way to make changes is slowly and over time. 

I give 1-2 exercises at a time, or one to 2 dietary or supplement changes at a time. I do this because patients are more likely to change 1 thing than 7, but also because if I change a bunch of things all at once, we don’t know what actually made you better. Too many variables in the experiment. 

It never ceases to amaze me how many patients are astounded when they do the exercises and they actually get better! Funny how that works. 

The Manifestation of Health:

What is health? When asked to define “health”, every patient has a different perspective of what health is, because health is personal. One patient’s definition of health may be to be able to walk through the grocery store once a week, while the next patient may define health as competing in a triathlon. Both definitions are valid and correct because both definitions give fulfillment to that patient’s life. 

One of the questions I like to ask patients to get to know them is “What are you not doing right now that you miss or would do if you felt healthy?” Patients are often taken aback by this question because it’s not something they get asked a lot. But I always enjoy watching patients think about what they would do because they all start to look a little wistful and peaceful when they consider doing things they love. 

Now, sometimes there are things that may be unrealistic for some patients, but this question allows me to discuss patient expectations and compromise regarding activities that may or may not be realistic. This also allows me to set up goals both short term and long term for care. 

When the Physician understands what health looks like for any one patient, they can make recommendations and discuss options with the patients goals and preferences in mind. If I know my patient really wants to avoid medications, I try to stick to natural alternatives and supplements (when reasonable). If surgery is not an option, I probably won’t send my patients to a surgeon, and so on.

Health (in whatever form) manifests through a partnership between patient and physician where patient boundaries are respected, preferences are considered, and goals are discussed and quantified. Patients “get better” when they know what is causing their symptoms, they understand how exercises and lifestyle changes are going to influence their function, and they respect their physician with honesty and effort.

Doctor Shopping

You wouldn’t stay with the first hair stylist you went to if they weren’t good at their job, right? So why would you keep going to a physician who doesn’t view you as a partner in health rather than a diagnosis, or an appointment on the schedule? 

Shop for your doctor! Find someone who fits your needs and understands your goals. If you live in a rural area or an underserved area this might be harder, but for the sake of your health if you are willing and able to drive a little bit to see someone who respects you, you’ll be much happier and healthier in the long run. 

Here is a list of questions you can ask or things to consider when choosing a primary care provider:

1. Do you prefer to see a physician, or would you be open to seeing a nurse practitioner or physician’s assistant? Everyone has their own opinion on this, so think about it before you seek out something new. Some osteopathic physicians also incorporate hands-on manipulations into their practice to augment care, or you can seek out an osteopathic specialist (like myself) for your manipulative care. 
2. Do you want to try to change your health through natural alternatives, or prescription options? Some providers are much more open to supplementation and “alternative medicines” than others. 
3. Insurance coverage is always a consideration when choosing a new health care provider. If you have the option, you can look into cash pay offices like Direct Primary Care or Concierge Medical Offices. These offices often have extended appointment times, on call hours, next day appointments, hospital visits, and generally more access to your provider than insurance based practices. 
4. Are you more comfortable seeing a male provider or a female provider? I know this sounds a bit obvious, but really think about it before you make an appointment. Which person would you be more comfortable sharing intimate details about your health with? This person will probably know more about you than most people in your life, so make sure you are comfortable being honest and open with them about your health and your body. 
5. Is your new provider’s office staff friendly and helpful? Nothing is worse than going to a new place and being greeted with indifference or condescension. When you call the office, is the receptionist warm and friendly? Does the staff respond to calls and requests quickly and update you if things are taking longer than expected? 

Before going to any new appointment I highly recommend making a document outlining your health history and your health goals. This is an easy way for a provider to get to know you and what you want out of your encounters. I know you always have to fill out a zillion pages of new patient history, but having this document will make it easier to remember information and transfer it into the paperwork, and it can be a living document that changes as your health changes. 

Here are some things to include in this document:

• Current medical diagnoses
• Prescription and over the counter medications you take
  • Include supplements
  • Include medications you only take when needed like tylenol for headaches
• Previous hospitalizations
• Surgical history
• Family medical history
• FOR WOMEN: ObGyn History
  • Pregnancies and any complications
  • Miscarriages/Abortions
  • Living children
  • Latest PAP smear, any abnormalities
  • Last mammogram
• Social history
  • Family situation- marital status, children
  • Employment
  • Tobacco status
  • How much alcohol do you drink?
  • Do you or have you ever done illegal drugs
  • Toxin exposures- mold, pesticides, fumes, occupational hazards
  • Trauma history (if you’re comfortable sharing)- motor vehicle accidents, falls, sexual or physical abuse, etc.
• Diet and physical activity
• Hobbies, favorite physical activities, leisure activities
• Health goals
  • What do you want to do that you can’t right now?
  • What is health to you?
  • In what time frame would you like to be able to achieve these goals?