Improving relationships in a broken system
Our health care system is broken, and ideas to change it aren't lacking. We can put more information in the hands of doctors, on the one hand, and give them better electronic medical records. We can empower patients, on the other hand, and make the visit patient-centered. It shouldn't surprise you that the second idea excites me more than the first – but both are important.
But – possibly since it is not amenable to a technological or a advocacy-oriented solution – I haven't seen much about the relationship of doctor and patient. No matter what system we have, or whether/how much progress we make in fixing it, relationships can be improved. Whatever initiatives we implement need to be bipartite. We can't train the doctor to improve their communication with the patient, in one room, and train the patient to be a better self-advocate, in another room, and expect what goes on in the exam room to be a neat addition of these two.
How do we make this happen? We need to make sure that improving the doctor-patient relationship is a priority in quality improvement. How should we do this? Thoughts please?
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Thanks for your comments. I agree with your points. I think I was trying to say that apart from doctor-patient communication (which is a much-studied field of research, even if clinical improvements are lagging the research findings) the doctor-patient relationship can use work as well. Incidentally, the NHS is a lot less broken than the hodgepodge of systems in the US!
Ok. (slight hijack) Re: US vs. UK health systems. We're gaining a number of private health providers which is causing the government to systematically degrade the NHS, by them trying to "improve" mistakes by previous government administrations rather than fix them. I could continue with specific examples if you wish.But back to the original question. . . I can't see how you develop a doctor-patient relationship when you have to have a specific power balance (in favour of the doctor) to allow the doctor to give a level of care sometimes degrading and/or painful to the patient. It's not on the level as a parent-child or teacher-student one, so certainly a peer-peer or friend-friend relationship would be out of the question. It's a quandry.
It's difficult, yes, but there are plenty of relationships in which there are power gradients (in some realms) but also, at the same time, a peer-to-peer relationship (in other realms). Think of day to day life when our friends/spouses/companions are better at certain things than we are, or have more information, but in the rest of life are on the same plane. I don't think such a "modified" peer-to-peer relationship is out of the question at all.
I can see how you would come to this conclusion, but in my opinion/experience, the main problem with a doctor-patient relationship, is in many cases the patient only sees the doctor when needed, as in illness or designated examinations (I forget if it's applicable in the US, but here in the UK, doctors have a automatic designation as a form of a notary public, and sign official documents, such as applications for a passport/driver's licence). In either case, from the patient's viewpoint, the doctor wouldn't be seen as someone to chat with in a semi-familiar form unless being it was being used as a distraction from fear. (as I said previously, with a preferred 15 minute time limit per patient for a doctor, the doctor might feel under pressure to not do that)
I suppose, for your ideal situation to aquire the relationship you're talking about, would be to have small practices within a limited population group/area, where doctors would be assigned as a "lifetime" posting as happens in some small outlying towns. The patients see the doctor as an extention of the fabric of their general life. It would be wonderful.
Within this discussion, it reminded me of the practice I'm with - it was originally located in a house within walking distance to my Grandfather's house, and many of my Mother's family would go there. The practice for many years (about 20 years) only had had three doctors. I first went there when I was 8 months old. and yes, there was many a doctor-patient relationship which developed to the point where the doctors were invited to family weddings and christams cards were exchanged (the practice had strings of Christmas cards festooning the waiting room in the countdown to christmas) I could see, growing up, that the changing NHS changed the doctor-patient dynamics for what we have now.
That was the NHS at it's finest, where the care of the patient was paramount. It's very obvious that now, the monetary balancing of a practice takes precedence. So sad.
Even if there's nothing the doctor can do, the fact a patient has been listened to and understood (granted, sometimes difficult if the patient is unable to clearly articulate what exactly is wrong or forget to tell the doctor all of the sympoms they're experiencing), then they feel cared for.
I'm a patient in the UK's broken NHS, and doctors have a guideline of spending 15 minutes per patient.
I've seen many doctors in the practice I'm signed with (I've been with it for over 40 years), and the best doctors in the practice (permanent or training), take the time to listen. They'll admit when they don't understand and ask questions. I don't mind if they don't understand - and I realise they can only work with the information given - but if they don't listen and get my "solution" wrong - it makes ME angry and disappointed.