Building a cooperative
doctor / patient relationship
January 2007 View PDF En
español
For the doctor …
Just as there are things patients can do to make the relationship
more cooperative, there are things the doctor can do as well. The
following suggestions are intended to help doctors deal with patients
whose expectations may have been changed by the epidemic or personal
education about treatments. Despite the dedication most doctors
feel, nothing has fully prepared either doctor or patient for the
crisis they now face together. Here are a few helpful hints.
Supporting your patients’ interests in their healthcare
Support patient interest in monitoring and treatment. While not
every potential treatment is worthy of support, every patient’s
opinions and health are. The more uncertainties a given treatment
raises, the more important it is that the doctor monitor its use.
Patients will often be willing to follow a doctor’s best-supported
recommendations if the doctor is willing to monitor the patient’s
other choices simultaneously.
Some doctors express fear that monitoring implies agreement. When
someone asks to be monitored in a course of treatment, it doesn’t
imply agreement—only support for the patient’s general
well-being. There are no legal precedents in AIDS in which a doctor
has been accused of malpractice for taking blood counts while a
patient used a drug against his or her recommendation. It is not
common, after all, for a doctor to deny care to a patient involved
in recreational drug use or abuse, so there’s no basis for
refusing to monitor use of a drug taken in the interests of healing.
Being flexible with your responses
Recognize that the uncertainties of the epidemic demand a flexible
response. The expectation that patients will passively follow orders
simply won’t work with everyone, certainly not when doctors
have no hard answers for many questions.
HIV has changed forever the way many people relate to their doctors.
The new assertiveness and knowledge won’t go away. To cope
effectively, doctors must learn how each person wants to be treated,
particularly in regards to degree and form of collaboration in the
healing process.
Describing both sides of the issues
Be prepared to describe both sides of the medical issues that confront
patients, and do not feel insulted if the patient chooses a different
option than you recommend. Doctors have always known that there
are two or more viewpoints on most issues. In the past, after making
their own synthesis of the pros and cons, doctors were often quick
to recommend their preferred solutions for their patients.
Today, many people take a strong role in the decision-making process.
Of course, such empowerment doesn’t automatically make the
patient right. Doctors should help persuade patients to do what
makes sense. Use of well-phrased questions, reasoning, shared information,
respect and patience on both sides best achieve mutually satisfying
choices.
Responding medically
In most instances, patients will use a treatment anyway if determined
to do so and the doctor is unable to sway them against it. Refusal
to monitor diminishes a patient’s confidence and may increase
the risk of harm.
Respond in a medical fashion to the uncertainties of unapproved
treatment or treatment strategy. Perhaps this means more frequent
visits, additional diagnostic tests, or more cautious reading of
laboratory markers. Added expense may be the price required of the
patient. Often, the doctor can take the lead in this regard, and
the patient must be prepared to heed the outcome of the monitoring
process.
Not pushing your patient
Don’t push patients to begin treatment before s/he is ready
to commit. Beginning a combination treatment regimen is a big step
and will change many things in a patient’s life.
For example, taking pills several times a day is a constant reminder
of HIV. Disclosure is often an issue: if the patient’s supervisor
and co-workers are unaware of his/her HIV status, the patient may
be reluctant to begin a treatment that must be taken during work.
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