Building a cooperative
doctor / patient relationship

January 2010     View PDF     En español

For the doctor …

Support your patient's interests in their health care
Support your patient's interest in monitoring and treatment. While not every treatment is appropriate, every patient's opinions and health are. The more uncertainties a given treatment raises, the more important it is that you monitor its use. Patients may be willing to follow your recommendations if you're willing to monitor your patient's other choices simultaneously.

When someone asks to be monitored in a course of treatment, it doesn't imply you agree with it—only support for your patient's 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.

Be flexible with your responses
Recognize that the uncertainties of the epidemic demand a flexible response. The expectation that patients will passively follow orders simply doesn't work with everyone, certainly not when doctors may not have answers for every question.

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 their healing process.

Describe both sides of the issues
Doctors have always known that there are two or more viewpoints on most issues. Be prepared to describe the many sides of medical issues that confront patients, and do not feel insulted if your patient chooses something you don't recommend.

Today, many people take a strong role in the decision-making process. Of course, that empowerment doesn't automatically make your 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.

Respond medically
Patients may use a treatment anyway if they're determined to and you may not be able to sway them against it. Refusing to monitor diminishes your patient's confidence and may increase the risk of harm.

Respond in a medical fashion to the uncertainties of unapproved treatments or strategies. Perhaps this means more frequent visits, other diagnostic tests, or more cautious reading of lab markers. Added expense may be the price and the patient must be prepared to heed the outcome of the monitoring process.

Don't push your patient
Don't push patients to begin treatment before s/he is ready to commit. Starting a regimen is a big step and will change many things in a patient's life.

For example, taking pills every day is a constant reminder of HIV. Disclosure is often an issue: your patient may be reluctant to begin therapy that must be taken around their family or at work.