Friday, August 14, 2015

The Changing Relationship Between Doctors and Patients

The Changing Relationship Between Doctors and Patients
By Michal Klau-Stevens

“What does the doctor say?”

That’s the question we often ask when a loved one has a health concern. We place great trust in doctors, because of their training and expertise. Yet, the doctor-patient relationship has changed over the past few decades in ways that have a direct effect on your care. Here are some things about the doctor-patient relationship that are different from how they were, even twenty years ago.

It used to be that you had a family doctor or internist who saw your care through from beginning to end. Today, there are many large medical practices, and while you may see “your” doctor for much of your care, it’s also likely that you will see other doctors in the practice, or get referred to a specialist. Medical care has become more compartmentalized, and specialists focus on certain body systems or illnesses. You may need to coordinate your own care while managing orders from several different doctors who may not see the overall health picture. If you need surgical or hospital-based care, you must be prepared to work with care providers who are strangers to you, and who don’t know your individual needs.

Also, the average medical appointment today is 7 to 15 minutes in length, where previously appointments were over 30 minutes. The teaching, conversation, and relationship building that used to happen in the exam room do not happen with the same depth as they used to. The interactions between doctors and patients today leave little time for developing a true relationship in which your physical, mental, and emotional needs are understood as deeply as they were in the past. The discussion time, and therefore the opportunity to develop personal connection, simply doesn’t exist today.

Another aspect of the doctor-patient relationship that is different from previous generations is the access to “special” information. It used to be that doctors’ training taught them information that was not available to patients, which made them authorities whose word was not to be questioned. Today, patients have access to vast amounts of medical information through the Internet, and can access far more data than was ever possible in the past. While most patients don’t achieve the level of medical learning that doctors have, they are able to engage in conversation about their care on a much higher level now than before. This patient access to specialized medical information changes the relationship from one of authority to one of partnership.

In addition to Western, or allopathic, medical information, patients also have access to information about a wide variety of natural, herbal, Eastern, and alternative healing modalities. Most doctors who are trained in the United States are not trained in these other types of care. Many doctors are skeptical about them because they differ so greatly from their “traditional” medical training and some modalities have little peer-reviewed scientific research to support their claims, even though they have been used in other parts of the world for hundreds of years. Patients who wish to use alternative therapies may find their doctor does not support their use, and conflicts will arise.

Medical schools don’t offer a lot of training for doctors on how to manage their relationships with their patients, and the landscape is changing faster than school programs can catch up with anyway. Patients vary in their knowledge levels, and the quality of information they are learning ranges from top-notch science to quackery, depending on its source. Since this shift is still happening, with some patients taking an active role in their care, and others still relying on doctors to take the lead, it’s not always clear to doctors or patients how to manage the changing relationship expectations.

Put together, these changes to the doctor-patient relationship have deeply affected levels of trust on both sides. When patients feel they can’t trust their doctors because they haven’t developed strong relationships with them, they may not feel secure in following their advice, which can cause serious problems. When doctors feel they haven’t developed a strong relationship with their patients, they can’t care for them as well and may be more likely to practice defensive medicine.

What does all this mean for you as a patient today?
This means the demands on you to advocate for your needs are stronger, because you may not be able to rely on a relationship with a trusted caregiver to guide your care. You must be more outspoken about what you need and want throughout your care, and you must develop skills to help you communicate effectively with unfamiliar caregivers.

In order to do that, you must be proactive in learning about your health needs or illnesses from trustworthy outside sources. You can’t assume your doctor will tell you everything you need to know because there is not enough time in typical medical appointments to give you all the information you will need to make truly informed choices.

Be prepared for your appointments by doing research in advance, and having a list of questions prepared with the most important questions at the top of your list.

Finally, you must seek out doctors and medical practices that match your care philosophy and approach to medical care from the outset. Each practice has its own work and medical care culture, and it’s up to you to explore all the options available to find which will be the best fit.

As frustrating as it can be to both patients and their doctors, the days of “just do as your doctor says” and “letting them take care of you in the hospital” are over. The changing doctor-patient relationship makes getting good individualized healthcare different now than it used to be. The times, they are a’changin’.

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!


  1. Good article, Michal. Change is inevitable, right?

    1. Yes, Daniel, it is. It's important that we, as consumers and patients, do our best to keep up. We are the ones who bear the consequences for our healthcare outcomes!