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.
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.
My doctor unsmilingly whips out a couple of instruments to peek inside my ears and nose as I wondered, do I still need to be naked for this part? This was my first appointment with her, just a routine checkup during one of my short trips back home in between semesters. It had been a while since I had seen this office, or any doctor’s office for that matter—my last physician from the same practice had turned me off of my regular visits for the last few years. She had been a younger family physician who was chosen for me randomly from a list of names, who I had always felt uncomfortable with for her icy demeanor and terse, judgmental questioning.
But a few issues had finally brought me back to the exam room, back to a new doctor (who I had also chosen from a list). I felt tired all the time, more so than my college student peers—enough to make me worry. I had lost a lot of weight over the past few months, and with my already-small-to-begin-with frame, I wanted to make sure I was okay.
Even though the room remains mostly silent, the most noise coming from that rustling tissue paper that separated me from the beige leather of the table, no natural opening has presented itself to tell her about my concerns yet. So I keep my mouth shut while she jots notes down on my chart.
The program’s creators openly admit that Doc Shop is a marketing tool—a way to draw patients and good press to the hospital. Dr. Vallery has attracted six new patients with the event, and Dr. Sherif Rizkalla, a primary care physician who participated in the most recent Doc Shop, has added one. With two more events planned before the end of the year and lots of positive media coverage already out there, the program has been and will be a success in that regard.
Luckily for patients, Doc Shop is coming at a time where compatible relationships with doctors are especially important. “For the last twenty years there have been concerns from not only people who do research in this area, but even in medical schools, about the idea of patient-centered care,” says Street. Increasingly, he says, patients want to take a more active role in their relationships with doctors, to have a hand in making decisions about their own treatment.
Bedford resident Jennifer Mills, a former 911 call operator and stay-at-home mom, heard about Doc Shop through Facebook. She attended a Doc Shop event looking for a new primary care physician. Patients like Mills asked basic questions about hours, availability, basic treatment—but were also interested in the doctors’ philosophies on patient care. Would they listen? Were they willing to negotiate? And even, was the small talk good? Mills says she was especially drawn to a doctor if the conversation flowed easily and naturally. She came away from the event having narrowed down her choices to three doctors.
Critics of the program argue that five minutes is hardly enough to make a decision about such a serious relationship—and the doctors and creators agree. But the time interval was chosen so the event would last an hour, lunchtime convenience being one of its major selling points. And Dr. Vallery says that certainly a five-minute conversation is a better way to choose a doctor than selecting a name from a list of physicians who take your insurance.
As for the researchers, they acknowledge the value, even if it’s limited, of the event. “I think there’s only so much you can do in five minutes, but I think it’s a whole lot more than you can do just from seeing a name and a medical school. So I applaud the effort,” says Haidet.
To maximize the quality of care, the most important thing for patients to do, the researchers found, is this: Speak up. That the patient feels comfortable enough with their doctor to open up is essential—the study found that when patients asked questions of their doctor and took a more proactive role during their appointments, their doctors understood them better (as demonstrated by the survey results). “If we get patients to be more forthcoming about their worries, their beliefs, their fears, their opinions, their preferences, whatever, doctors are going to get a better read on where they’re coming from and then hopefully use that information to come up with a treatment plan better suited to that person’s circumstance,” says Street.
Street and Haidet agree that Doc Shop puts patients in a better position of finding a doctor with whom they can be honest, and, at the very least, gives patients the power of somewhat informed choice. “It’s a step in the right direction in terms of feeling comfortable with someone you’re starting a relationship with. It is not a panacea, it is not a solution to bad care, it is not a quick fix. It does get you starting off feeling better about your first visit. You know a little bit more about one another and that’s a good thing,” says Street. And Dr. Vallery says she believes the patients that came to her through Doc Shop do seem to be more open with than patients who found her name on a list.
“Doctors aren’t always very accurate judges of their patients’ health beliefs. They tend to think patients see things the same way they do. But when patients speak up, there’s a better opportunity to have a better understanding. Not that doctors are bad and ignorant, but just like anything, what is it we can do to help each other understand each other better? Talk,” says Street. “It’s a pretty simple idea.”
After another few minutes of prodding and peering, she rolls her metal stool briskly away from me with her feet. “You seem perfectly healthy, which at your age, doesn’t surprise me. Anything else?” my doctor asks, closing my chart and glancing at the clock. The appointment didn’t last nearly as long as I thought it would. But now was the time to tell her about my concerns. The tiredness, exhaustion, the weight loss… “Nope,” I say. “Nothing.” I thanked her and she left the room. I took off my bicycle gown and pulled my clothes back on. I wove through the hallways, back out through the waiting room, got in my car, and drove home.
“The good thing about Doc Shop is at least [patients are] not going into a situation where the doctor is a total stranger,” Street says. “The way the patient ought to think about it is this: At least I found someone, I initially think I’m going to like. I like their style, I like their smile, the way they talk to me.” With a new pool of doctors and patients, Texas Health Presbyterian Hospital Plano, with help from Doc Shop’s pioneer hospital, is planning on hosting its first doctor speed dating event next month.
Speed daters may come out ahead, but Doc Shop or not, patients have ways to improve the healthcare provided by their physicians. “There are things you can do to make that doctor a better doctor for you, and for that matter, you a better patient in your own care,” Street says. “A person’s ability to communicate, particularly the patient, can make doctors better.”