Doctors are from Jupiter, Patients are from Saturnby Lori Baker
"Of course, doctors and patients are not alien beings, but it's a good illustration to help explain why interactions between them can be difficult," said Dr. Paul Haidet, a health services researcher at Baylor College of Medicine who has been studying the doctor-patient relationship for 11 years. "Doctors are members of a medical culture with its own language, style of communication, and accepted behaviors, and patients are part of a different culture. "If these differences were obvious to the two, they would realize they have to find ways to understand each other," said Haidet. "The problem is that doctors and patients usually don't know there are differences, which can result in miscommunication, frustration, and a less-than-ideal relationship." Over time, the doctor-patient relationship has evolved. One key difference is that many people no longer have one primary doctor who treats them most of their lives. Today, health plans change frequently, new doctors must be found, and those long-term relationships— and the knowledge base that went with them—are lost. Not only has the relationship changed, but how care is provided is also shifting from "doctor-centered care" to "patient-centered care." In the past, doctors primarily controlled the information and made the decisions. The patient-centered model, in which doctors and patients work as partners, has shown to be a more effective model. Studies over the last three decades demonstrate that when doctors are more patient-centered, patients not only are more satisfied and have greater trust, but they also better adhere to their treatment plans. In addition, hypertensive patients have lower blood pressure when their doctors are patient-centered, and blood sugar levels are better controlled in diabetic patients. "In one of our studies, we found that students tend to become less patient-centered as they progress through their medical education," said Haidet, who is an assistant professor of medicine at BCM and a staff physician at the Michael E. DeBakey Veterans Affairs Medical Center in Houston. "Although they are being taught patient-centered lessons in the classroom, other factors are influencing them—such as how physician role models behave toward and talk about patients, what things are reinforced in evaluations, and advice students receive." Haidet also developed a tool that medical schools can use to gauge how patient-centered their "culture" is. During testing, Haidet discovered that the medical education culture is not uniform: Some schools are more patient-centered overall than others, and, within a given school, certain aspects of the culture could be more patient-centered than others. "This type of tool can be used to help medical school leaders decide where to focus their efforts to affect change," said Haidet. Making changes within a culture is not easy. One of the first steps is to weave relationship-building and communication skills back into the fabric of medicine. "Today, there are many wonderful technological tools available in medicine," said Haidet. "Unfortunately, access to these technologies has turned many doctors into expert technicians instead of healers." Doctors also feel more pressure to care for patients in less time. As a result, their communications skills suffer in order to be more efficient. They believe that diagnosis and treatment, not relationships, are their core responsibilities. "What we need to reinforce among physicians is that there can be a tremendous treatment potential through relationships," said Haidet. Several BCM faculty members, including Dr. Haidet, have recently received grants to continue researching the doctor-patient relationship and to incorporate communication skills and relationship-building into the curriculum at Baylor College of Medicine. According to Haidet, the changes must also happen among practicing physicians, who are the role models for student physicians. If students don't see the classroom concepts and principles in the real world, said Haidet, they might literally sound out of this world when they're ready to treat patients. |
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Volume 2, Issue 3, Fall 2006 |
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