Health & Wellness

The Patient’s Power: The Physician’s Office

Elizabeth Maxwell
By Elizabeth Maxwell

Catchy title, right? Let’s examine the power you have as a patient and how it can benefit you.  Like Dorothy in the Wizard of Oz who didn’t understand that she had had the power to return home to Kansas, a patient often has no clue about her power in the sacrosanct doctor-patient relationship.  Why not? Because no one informed her! Though not surreptitiously devised, the legal concept of informed consent which protects a patient’s power, preceded through courts more so than newspapers (or later social media) in the decades since 1913 when it first appeared in court.

Yet, the present diversity of religious and non-religious values within the melting pot of nationalities that has always been America, means the knowledge of patient’s rights has never been more important. While nuances for informed consent are complex, its basic tenant is very simple: a person’s body is a physical boundary which may not be touched or treated without the adult’s (parent or healthcare surrogate for minors) permission.

Your permission is required for medication, therapy, or surgery. The corollary though is equally true. Consent isn’t consent unless you can refuse. Otherwise instead of consent, you would be merely providing assent.

The goal of informed consent isn’t just to say yes or no to a proposed curative/restorative action, but rather open a dialogue between patient and physician for an agreed upon plan of action. Dialogue requires questions and answers from both the physician and the patient. It is critical that patients realize that physicians do not have extra sensory perception: you need to tell them what you are thinking/fearing/why you made the appointment. Physicians today may be better trained to comprehend and anticipate a patient’s fear, but no medical college can train physicians to “make” patients speak honestly.

It remains true that actions speak louder than words and especially the lack of words. The physician will likely be rushed trying to see a waiting room full of patients and preoccupied with doing a good job as quickly as possible which inadvertently makes the patient feel devalued and as though she is less important, less sick, and should take less of the physician’s valuable time. Given insurance’s imposed high number of daily office visits, the physician’s workload is a reality. Understanding your legitimate expectations and reality enables you to better access your perception.

Just as the physician has duties and responsibilities, so do we as patients. Power never comes alone, but rather comes with responsibilities. To engage in dialogue with your physician, you need to arrive prepared. This will require time on your part well ahead of the visit itself. Write down your questions.  To get the most from your costly office visit, think of any aches, pains, changes (eating & sleeping habits, mood, social interactions, increase/decrease in exercise, relationship changes) in addition to your primary reason for the visit. Your health and well-being involve your life which is why an exam is more than a silent physical assessment. Once written down, arrange it in concise, logical order. This preparation permits you to

  1. not miss something,
  2. make the most of your brief office visit,
  3. demonstrate you respect yourself and your physician by your responsible action,
  4. understand your active role in your own health care.

Of note is the fact that you will get a “dress rehearsal” of this conversation with your physician by stating all of this to the nurse who sees you ahead of the physician. Just know that you will say this twice; it may help relax you before you review this with the physician if you are not used to this higher level of interaction previously.

Respectful preparation also means your physician is better able to treat you because information is readily accessible. Remember, physicians do not possess extra sensory perception. Rather than being riddled by questions, your pro-active stance fosters a different type of interaction with your physician immediately. You are conveying that you know your rights and will be an active participant in treatment options, i.e., you will have legitimate questions.  This is a good thing for both of you, not a threatening thing to your physician.

The crux of the matter is valuing what each party brings to the relationship. A physician brings medical knowledge and clinical experience (has seen treatments and outcomes for many patients in your situation). A patient brings personal values and knowledge of her body. This is exactly why a lack of dialogue itself can bring undesired outcomes. The patient must understand the physician’s opinion of what is occurring and proposed treatment plan as well as risks of proposed and alternate treatment plans. When the physician asks you, “Do you understand?” and you say, “yes,” when you do not, a physician has no way of knowing if you do or if you are acquiescing.  Answering honestly a physician’s question is always the only right answer.

It isn’t easy being a physician, and it isn’t easy being a patient either. Both require very different types of “work” and effort. For a healing partnership, it is critical that both partners understand their roles. While less than optimal partnerships are the norm, greater therapeutic value occurs when roles are understood. Physicians exist to promote health. Sick visits will hopefully result in health restored. Well visits (for prevention) result in health being maintained. However, when we view this partnership only from the perspective of the active physician “treating” and a passive patient, we miss the patient’s vital daily role. Once understood, the patient agrees to comply to the treatment plan and if she doesn’t, then she dishonors that agreement. That is a discussion for another time. When patients don’t understand their role, they cannot participate fully in a health promoting outcome.

When your physician suggests a medication, you ask about if it is new and its possible side effects. If you don’t understand what a particular side effect means, then you ask. If you don’t know the explanation or the terms, state specifically where you got lost and ask again. If the medication is new, is it more expensive than previously prescribed medication? If yes, then why is it better?  Your physician can supply that answer in a couple of sentences, which is all you are seeking. If the answer is because the pharmaceutical rep said it was, get a different physician. Afterall, after your co-pay, you will likely be responsible for the remaining cost of the prescription. These are legitimate concerns which deserve answers before you agree to do your part.

Informed consent means that you have the right to disagree with your physician and to seek an opinion at a different physician’s practice. Seeking a second opinion is always legitimate but asking the physician who you should get a second opinion from is not. You do not have the right to demand a specific treatment from a physician; physicians are not short order cooks. However, you do have the right to understand why one proposed course of treatment is better than another for your situation. Pharmaceutical companies that flood our media with advertisements with the latest medications do nothing to help you understand what is best for you. They advertise what is possible, not what is best. After all, the purpose for advertising is to sell a new product and at a cost so high, the pharmaceutical company may have to cover part of the “cost.” Bless their hearts.

A therapeutic relationship with your physician requires clear and honest dialogue. Use your power as a patient to promote your own healing. Being forthright and asking questions allows your physician, with your input, to devise your best course of action. Having this power as a patient promotes your healing/health. I hope that this short piece is thought-provoking. Please email me at ethics.maxwell@gmail.com if you have points of concern you wish to discuss.

Elizabeth Maxwell
Elizabeth Maxwell, a native of NC, did her undergraduate work at Wake Forest University, a masters in religion at Smith, and a master’s in clinical ethics at UVa. In addition to a long career in teaching and freelance writing, she...Read More
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