Romancing the Patient
Is speed dating the surefire way to building a healthy doctor-patient relationship?
My doctor’s hands are cold. When she first enters the exam room, she tells me to take off “everything” I was wearing and put on a gown that sat folded on the tissue paper-covered bed that I chose to stand next to rather than sit on. Then she left me alone so I could change and be with my thoughts.
Everything? I wasn’t sure if she meant everything, or just everything from the waist up (or maybe just from the waist down?), but in the moment I had decided not to ask. To be safe, everything it was. Now she’s back in the room and reaching under my bicycle-patterned cotton gown and wordlessly doing something to my naked abdomen—feeling around to make sure my organs are in the right place. Goosebumps pop up all over me as I shift uncomfortably on the tissue paper table and silently wish cozy wool gloves were part of the medical tools surrounding me.
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One afternoon last summer, Mandy Forbus, the senior marketing specialist of the Texas Health Harris Methodist Hospital Hurst-Euless-Bedford, walked into the office of Mary Lou Wilson, the director of women’s services, with a novel idea. The idea was for a program that would later be called Doc Shop, a series of hospital-sponsored events where patients could “speed date” for their doctors. People could come in for a free, convenient lunchtime session at the Fort Worth-area hospital and be allowed to choose from a room full of doctors waiting to hear their concerns. The program began with obstetricians and gynecologists, who were eager to give the event a shot. “It seemed like a novel idea,” says Dr. Kristen Vallery, OB/GYN, who was part of the first Doc Shop.
It goes like this: Soft music plays in a staging room where patients gather before the event starts, and a boxed lunch—a salad or some such—is provided. When the door opens to the main room, a doctor is sitting at each of about a dozen round tables all decorated with a tablecloth and small vase of flowers. Each patient takes a seat at one of the tables, a bell rings, and the room fills with chatter. Five minutes later, the bell rings again, and patients rotate tables to talk to a new physician. And so it goes for the next hour. Since then, there have been eight Doc Shop events at the hospital and the program has expanded to include pediatricians (parents are not advised to bring their children on dates) and primary care physicians.
Richard Street, professor of communication specializing in clinician/patient relationships at Texas A&M University, recently conducted a study to find out how well doctors really understand their patients. He and his co-author Paul Haidet, professor of medicine and humanities at the Pennsylvania State University College of Medicine, say they got the idea from earlier studies that show drastic differences between the health beliefs of doctors and patients of different races and ethnicities. Could those differences exist between doctor and patient even when race isn’t a factor?
Physicians and patients from the Houston area were gathered for the study. Patients took a survey assessing their health beliefs on certain levels—whether they believed illness was their fault, was under their control, whether natural remedies would work, and other measures related to how the patients felt about their health. After meeting with the patients, the doctors took the same survey and tried to guess what their patient had put down. The result? “We found all kinds of misunderstandings going on,” says Haidet, “and that’s not terribly surprising.”
The study specifically sought out “average” participants—non-immigrant patients receiving regular primary care for common ailments like high blood pressure—to see if the differences existed in those relationships too. The doctors’ survey answers indicated a statistically significant amount of disparity from their patients’ health beliefs. “Sometimes there are these big cross-cultural misunderstandings but sometimes there are these little tiny misunderstandings that can totally snowball out of control,” says Haidet.
The authors of the study say that disparity can be dangerous. “It tended to be related to the patient’s beliefs about satisfaction with their care, and their desire to stay committed to the treatment recommendation that the doctor made,” says Street. Misunderstandings can diminish a patient’s quality of care. What if, Haidet says, a patient can’t take her medication because it causes side effects that affect her job? “So when she comes back to the physician, he figures out by looking at her labs that she’s not taking the medicine. And the physician asks her if she’s taking the medicine, and if there’s a big power differential, she lies and says yes. And the physician thinks this is a bad patient and writes in her chart ‘noncompliant,’” he says. “Well, every nurse and every physician from then on is going to label this patient a bad patient when there is a real reason she’s not taking the medicine.”
Street says patients are often reluctant to be open with their doctors because they’re afraid to waste the doctor’s time, afraid to seem like they’re challenging the doctor, or don’t want their doctor to disapprove. “They hold back because they think their role is to be quiet unless they’re asked or they don’t want the doctor to think ill of them,” he says. Doctors tend not to solicit that extra information, says Haidet, and both patients and doctors often feel there’s not enough time to talk about those kinds of things. “The average patient isn’t necessarily that active and won’t just come out and say it, or really feel empowered to,” he says.
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