Sure you are comfortable with your current doctor, after all you are still alive and kicking.  Besides it has taken you years to figure out what you can safely tell your doctor and when it’s ok to speak up.

Yes, the fact that your doctor is often late and never seems to listen to you bothers you just a little.  You aren’t displeased enough to stop giving your doctor high satisfaction scores.  After all who wants to upset their doctor?   But admit it, you have wondered if there isn’t a doctor out there that would be a better fit with you.   I know I have.

Doctors probably feel the same way about many of their patients.   It can’t be easy everyday trying to help patients that don’t seem to want to help themselves, or who want a quick fix from a bottle of pills.   Not to mention patients who habitually miss their appointments and are generally non-compliant.

How would changing doctors help?

The problem with established doctor-patient relationships is that each side makes too many assumptions about the other, presumably based upon their history together.   This “familiarity” carries with it significant, potential risk.

It is widely reported for example that anywhere from 40% to 70% of patients that use non-traditional sources of care do not tell their physician.  Why?  Because they assume that their doctor will chastise them for doing so.  Two-thirds of patients never tell their doctor that they can’t afford their medications and split their pills to make them last longer.  Why?  Because they presume their doctor doesn’t care since they never ask, or that there is no way their doctor can help since they have never volunteered help in the past.  Up to 50% of patients walk out of their doctor’s office without knowing what their doctor told them to do.   Why?  In part, because they assume their doctor is too busy for them to interrupt and ask for clarification.  I think you get the idea.

Physicians are often just as guilty of making assumptions about their patients.  Physicians assume that every patient these days is “empowered” and wants (and knows how) to take more control of their health.  Why?  Because that what they read in the industry press.  Forget the fact that for the previous 100 years doctors have been the experts and have controlled the medical interview process.  Physicians often acknowledge giving up on counseling patients against obesity.  Why?  Because physicians assume that patients should know better.   In fact, studies have shown that my obese patients have never been told they have a weight problem by their doctor.   If as a patient you grew up believing that the doctor would tell you whatever you needed to know, well, you could see how there could be a possible disconnect here.

By changing physicians, patients would be forced to questions the assumptions they had made about their old doctor.  The same is true of the physician.   At a minimum, patients would hopefully have learned what they wanted in a physician relationship and how to get their needs met. Doctors would learn that it is easier and less time consuming to keep an existing, “known” patient healthy and satisfied than it is to start over with a new patient.

My point?

Physicians and patients, like most human beings, make a lot of assumptions that color how they talk with and relate to one another, sometimes to the detriment of both parties.  Dissatisfied patients are more likely to just leave your practice than complain on a satisfaction survey.   Isn’t it easier and ultimately better for all involved if patients and physicians routinely check their assumptions at the door?

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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