Doctor/patient relationships

We find constructive solutions to building a healthy relationship with your doctor.
 
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01 .Introduction

Doctor-patientWe asked readers about their own personal experiences and consulted several large external surveys of both doctors and patients to establish the most common gripes, and found that many of these annoyances are avoidable. By actively engaging with your doctor in a constructive way you’ll build a better partnership and get better care. Here's CHOICE's guide to getting the best out of your next doctor's appointment.

See our Health section for helpful tips such as how to choose a good GP.

 

What annoys patients about doctors?

Poor bedside manner

  • Doctors who don't listen to what their patient is saying, don’t appear interested or act empathetically. Many patients sense a lack of respect, and say they’re made to feel like hypochondriacs.
  • Fear of judgment and sermonising from doctors if a patient comes clean about taking drugs, sexual practices or lifestyle issues. If patients find some doctors’ contempt for alternative medicines and therapies irksome, they’re less likely to mention using them.
  • Personality traits or mannerisms of one or both parties may sometimes prove intractable, so it might be time to try a new doctor.

Waiting ...

WomanSneezing_iStockEspecially if an appointment has been made for a specific time.

Waiting rooms fill up. Patients arrive with a long list of ailments, queries and concerns - without booking a longer appointment; people present with what seem like simple issues that turn out to be more complex; emergency cases need to be fitted in; extra time may be needed for doing tests.

From May 2010, the Medicare payment to doctors will increase for longer appointments, making it more attractive for them to spend a longer time with patients. However, the rise is only a couple of dollars so it might not make a great deal of difference, and if it does, it may eventuate in doctors seeing fewer patients.

Blinkered vision

Patients get frustrated when doctors don’t look beyond the obvious diagnosis and treatments.

“I had horrible dermatitis on my hands and kept being given creams to put on it. It never went away and I suffered for months. I hopped on Google and it suggested giving up milk/lactose. I did and my hands cleared up in less than two weeks. Coincidence? Maybe. But food allergies and intolerances are not uncommon - doctors should know or perhaps suggest these things, rather than just attempt to cure a particular symptom.”

Over-prescribing

PillsInHand_iStockSome patients would prefer a pill to make all their problems go away, others would prefer constructive lifestyle advice or alternative therapies. If nothing is needed - they’d rather have nothing.

Consumers express concerns that doctors sometimes don’t know enough about medications they’re prescribing, and are overly reliant on information from the drug companies. Many are also disappointed by the lack of information they receive about how to take the medicine and possible side effects.

Mind the gap

Patients resent paying a full consultation fee just for a repeat prescription or referral renewal, which takes a matter of minutes. By contrast, doctors get frustrated when patients happily pay hundreds of dollars for alternative practitioners and therapies with no evidence they work, but complain about having to pay a few dollars for the Medicare gap.

 
 

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Doctors' frustration with certain behaviours or habits of patients can affect the quality of health care the patient gets.

Disregarding lifestyle advice

AppleweightiStockDoctors advise that many health complaints can be treated or reduced by making lifestyle changes: eating better or less food, exercising regularly, stopping smoking and getting enough sleep.

Many patients don’t follow this sensible advice and can be unwilling to make lifestyle changes, preferring instead to take a pill – and some doctors acquiesce.

Sometimes the patient doesn't know where to start. Broad advice to eat less and exercise more could be supplemented with a referral to specialists such as an Accredited Practising Dietitian or exercise physiologist – perhaps even a psychologist. And this: "Having an overweight, unhealthy looking doctor lecturing me about my lifestyle is a bit rich".

Self-prescribing

It’s now becoming increasingly common for patients to begin the consultation with a demand for a prescription medicine they’ve researched themselves, rather than seek their doctor’s expert opinion for a diagnosis and treatment recommendation. It’s usually better to leave medical advice to your doctor than the internet.

“It’s good when patients do their own research, but I hate it when they just demand a particular medicine without asking my opinion as to whether that's the best option.”

If a medicine doesn’t agree with you, don’t just stop taking it – tell your doctor, as there may have been a dosage error or the side effects may be otherwise avoidable. Side effects may also be important and noteworthy in terms of the medicine’s safety profile, and should be officially recorded on adverse events databases.

“Nothing worth mentioning…”

iStock_alternative-medicinePatients often don’t mention taking herbal medicines, either because they’re “natural” and therefore don’t count as drugs, or because they’re worried the doctor will show contempt. But herbal medicines are not always safe for people with certain conditions, and may not be safe when taken in conjunction with certain prescription medicines.

Patients argue that until doctors show more respect for alternative therapies, they’re unlikely to be more forthcoming.

Extreme reticence

Procrastinating before going to the doctor means valuable treatment time has been lost and the patient has suffered. Other patients may be embarrassed about coming to the point and skirt around the key issue, leaving their doctor unsure what’s really going on. Finally, there are the “doorknobbers” who spend the appointment chatting about matters of little significance, and just as they’re leaving, with their hand on the doorknob, will say “oh, and by the way…” – and out comes the main concern.

Not to mention patients who compile over the months a list of maladies and requests for tests and referrals, and save it all for one bonanza appointment – for which they’ve been allocated the standard timeslot. If you have a lot to talk about, make a longer consultation, or better still, several.

 

03.Getting the most out of your appointment

 

Asking the right questions can go a long way towards better health - here are some key tips and strategies to help you get the most out of your appointment.

DoctorscoatJust ask your doctor

Our US sister organisation, Consumers Union, compiled these questions to help you make the most of your consultation with your doctor:

Ailment

  • What is my exact diagnosis? What’s the cause of my problem?
  • How long will I be sick? 
  • How long before I’ll see improvement?
  • Under what conditions should I call you or come back? 
  • Can you recommend any sources of information?

Tests

  • Why is this test necessary? What will it tell us that we don’t already know? 
  • Will the results significantly alter any treatment plans?
  • When will the results be ready? Should I call you for them, or will you call me?

Treatments

  •  What treatments are used for my condition? Which is best for me, and why? 
  • What does the research show about this treatment? 
  • Is there any research on the horizon about treatments for my condition? 
  • What can I expect from this treatment, based on your experience? 
  • What are the side effects of this medication? Will it interact with alcohol, caffeine, or other drugs or supplements I take? Will it make me sleepy? 
  • Are there any alternative treatments appropriate for me to try, either before or along with conventional treatment?

Lifestyle changes

  • How will these changes help my disorder?
  • How soon should I expect to see an effect? 
  • How drastic do the changes have to be to produce real results?
  • Do you have any tips that would make these changes easier?

How can you get the best health care?

  • Ask friends and relatives for recommendations There are many great doctors around, and if you’re not happy with your own, you’ll probably find somebody who is.
  • Ask for a longer appointment if you have more than one issue to discuss. The Medicare gap payment for a longer appointment may be similar to a short one.
  • Take someone with you A friend, relative or spouse can help you remember everything you want to raise with the doctor. They can take notes for you while you talk, and also help you make sense of what you were told. However, this can be counterproductive if that person makes it difficult for you to speak frankly or if they interfere with the conversation, so choose your companion carefully.
  • Write down the medical concerns you want to talk about in order of priority, and make a follow-up appointment if necessary.
  • Talk clearly and frankly You’ll get better care if you explain your concerns as clearly as possible. Talk about your problem without embarrassment – the doctor’s probably heard it all before.
  • Ask questions It’s your body and your health – if you don’t understand something, ask for clarification. If you feel you need to know more, ask where you can find further information.

 

HospitalFilesIf you’ve had a bad experience with a doctor or any health professional, you should complain. The doctor may not actually realise they’ve caused mental anguish or offence, and your complaint may discourage them doing it again.

For serious complaints, your actions can protect others from an incompetent or unprofessional GP. Put your concerns in writing, complete with names, dates and places. Do this as soon as possible after the event so you don’t forget details. Send a letter to the practice manager or hospital, and give the doctor a chance to respond.

If there’s no response, or you’re not satisfied with the response, take it to the health care ombudsman in your state or territory who will determine the most appropriate way of dealing with your complaint. If it’s considered unjustified or frivolous, it will be dismissed; if a serious complaint is upheld, it may warrant disciplinary action and/or the doctor’s deregistration.

The most common official complaints about doctors relate to: 

  • Poor treatment: misdiagnosis, wrong or inadequate treatment. 
  • Problems with communication, including poor attitude and the provision of wrong or inadequate information, for example about the treatment. 
  • Professional conduct, such as incompetence, assault, sexual misconduct, fraud and other inappropriate behaviour, and impairment due to drugs or alcohol. 
  • Medication: prescribing or administering incorrect or inappropriate medication.

HEALTH CARE OMBUDSMEN

ACT
ACT Community and Health Services Complaints Commissioner
(02) 6205 2222

NSW
Health Care Complaints Commission
1800 043 159 (within NSW)
www.hccc.nsw.gov.au

NT
Commissioner for Health & Community Services Complaints
1800 806 380
www.hcscc.nt.gov.au

Queensland 
Health Quality and Complaints Commission
1800 077 308 (within Qld excluding Brisbane), (07) 3120 5999 (Brisbane)
www.hqcc.qld.gov.au

South Australia
The SA Ombudsman
1800 182 150
www.ombudsman.sa.gov.au

Tasmania
Health Complaints Commissioner
1800 001 170 (within Tasmania)
www.healthcomplaints.tas.gov.au

Victoria
Office of the Health Services Commissioner
1800 136 066
www.health.vic.gov.au/hsc/index.htm

Western Australia
Office of Health Review
1800 813 583 (within WA)
www.healthreview.wa.gov.au

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