Building a cooperative
doctor / patient relationship
January 2007 View PDF En
español
If disagreements occur …
When disagreements occur despite a cooperative relationship, it’s
difficult to know what to do. In consideration of active disease
states, such as a bout of PCP, the doctor’s expertise must
lead the way because the course of treatment is better known and,
in many instances, there is a degree of medical consensus. Exceptions
may occur in institutions or areas of the country where expertise
with HIV is not at a state-of-the-art level, or when bureaucratic
procedures may hamper the quality of care. In these cases, a second
opinion should always be sought from doctors in the leading AIDS
hospitals, and doctors can be referred to the WARMline.
When considering treatment of HIV infection and immune deficiency,
disagreements about treatments often occur in a very different context.
When patients may have as much information as the doctor about some
therapies, each may arrive at different conclusions based on similar
data. This presents a challenge for both.
A doctor must feel that he or she is practicing sound medicine,
yet the patient may feel s/he cannot compromise on a treatment option
s/he considers essential to his or her health or survival. In this
instance, both must strive to listen and understand the other’s
views. Rather than butting heads, both must seek to find ways to
satisfy the other’s needs and concerns. Both must begin by
acknowledging a common goal of keeping the patient alive and maintaining
health. Sometimes, it’s possible to find new alternatives
that neither party had expected before the discussion began.
The patient might ask:
“What will it take for you to feel comfortable with what I
want to do? More careful monitoring? Reviewing the decision in a
month or two? More review of available data? Discussion with other
doctors? A statement releasing you from liability?”
Similarly, the doctor might ask:
“What can I do to help you better understand the risks and
why I ’m concerned with what you want to do?” or “What
other options, if any, have you considered?” or “Will
you wait while I review the matter more carefully?”
While this type of dialogue is very productive, it won’t
overcome every obstacle. Patients cannot expect doctors to heartily
support the use of remedies for which there is no supporting evidence
of any kind. Nor can patients realistically expect doctors to give
the same credence to highly experimental approaches as they would
to better proven therapies. And doctors can’t realistically
expect patients to “wait and see” indefinitely while
the research proceeds.
At the very least, both parties must take the time to fully understand
each other’s beliefs and the reasoning behind them. Simple
confrontation over opposing conclusions is unproductive for both.
If, in the final analysis, the doctor cannot feel comfortable cooperating
with unapproved or unorthodox treatment strategies, and the patient
is equally firm in his or her convictions, then doctors and patient
must question whether it’s possible to continue having a mutually
acceptable relationship. In many instances, it is possible to maintain
the relationship while disagreeing and continuing to communicate
over the differences. The option of changing doctors should be reached
only as a last resort, and only when it is clear that the parties
cannot accept each other’s approach to the relationship. Each
of us must ultimately find the combination of patient + doctor +
approach that makes a cooperative relationship possible.
NEXT