Building a cooperative
doctor / patient relationship

January 2010     View PDF     En español

If disagreements occur …

When disagreements occur, it's difficult to know what to do. When an active disease appears, such as a bout of PCP, the doctor's expertise must lead the way because its treatment is better known. 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. Then, a second opinion should be sought from doctors in leading AIDS hospitals, or doctors could call the WARMline at 1-800-000-0000.

Disagreements about how to treat HIV may occur. When patients 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 s/he is practicing sound medicine, while patients may feel they cannot compromise on treatments they consider essential to their health. Both must strive to listen and understand the other's views. Sometimes, it's possible to find new options that neither party had expected before the discussion began.

The patient might ask:
"What will it take for you to feel comfort-able 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?"

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?"

However, patients can't expect their doctors to heartily support remedies for which there's no supporting evidence. Nor can patients realistically expect their doctors to give the same credence to highly experimental drugs as they would to better proven therapies. And doctors shouldn't expect patients to "wait and see" indefinitely while the research proceeds.

Sometimes doctors and patients must question whether it's possible to continue their relationship. It's possible to maintain the relationship while disagreeing and continuing to communicate over the differences. Changing doctors should be reached only as a last resort, and only when it's clear that you both cannot accept the other's part in the relationship. Each of us must ultimately find the combination of patient + doctor + approach that makes a cooperative relationship possible.