Great (or not so great) Expectations

Do you know what your expectations are when it comes to interacting with doctors and their staff. I bet you never even really thought about it (unless you’re a frequent visitor and have experienced letdowns and disappointments). In this chapter we begin to touch on the major communication problems patients will experience unless the doctors learn how to listen and interact with the patient as a human being, not as an object. We’ll touch on the fact that some of the patients’ expectations are unrealistic or at least next to impossible for the doctor to fulfill no matter how good he is. There are others that the patients have every right to expect – for example, talking to them in a language they can understand.

Patients expect relief, not a workup

It’s interesting that people want to quantify their problems. It’s as if “numbers” equal severity – the number of stitches, the number of hours (of an operation), the number of tests done, the number of medications taken, etc. When you go to the doctor, you’re not usually looking to see how many tests you can have ordered for you. You’re going because you don’t feel well or there’s something going on that’s concerning you. It’s not a contest to see how many specialists you can see. You want the Rolaids treatment – you want R-E-L-I-E-F, not a workup. It’s nice for those people who are being supported by your payment or co-pay but it simply delays feeling better.
Back to the question a doctor should ask himself every day and even several times a day: What if this were me or someone in my family? What kind of workup would I do? If they treated you like themselves (sounds sort of like the Golden Rule huh?) people wouldn’t have such negative thoughts towards doctors.
R-E-L-I-E-F comes in at least two flavors: physical and emotional. The physical relief is most important when you’re having pain.
The other kind of relief, psychological, is just as vital in your evaluation and treatment. You cannot address one without the other. If you’re not in physical pain, then there is another reason you’re in the office. This is usually a concern over something that’s happening in your body. It may just be discomfort, a form of pain, or it may be a worry, an emotional pain.
This emotional pain is something that usually accompanies all reasons to go to the doctor. Maybe an exception would be a “cold”, where you feel like the dickens but know you’re not going to die and that you don’t have a serious illness, but you still need something for relief. Even though technically this is not pain, it’s certainly discomfort and causes dysfunction.
Don’t be mistaken; there is emotional pain that accompanies even a “simple” cold. There is the concern as to how long you’ll be down. Will you be able to go to work tomorrow? Will you be able to go to the party Friday night? Will the others in the family get it? This is emotional pain and needs to be addressed too.
The person who sees a black spot on his arm is in significant emotional pain and worry, but not in physical pain. Their worry and concern is that it’s a malignant melanoma, a very bad skin cancer. FEAR requires R-E-L-I-E-F.

Patients expect the doctor to diagnose them quickly

No matter what it takes, you want a diagnosis now. You’re in pain and need help. You’re dependent on the doctor to help you get out of pain. First you’d like an appointment quickly, then to be seen quickly once you’re at the appointment. Like when you have a party, you want people to come at the time you put on the invitation. When someone comes to a party they expect you to be ready at the time on your invitation. Shouldn’t your appointment be the same way? Why is it any different? Maybe it’s because it’s not like a party in any other way. A “GI cocktail” is not a party drink.
Unfortunately patients expect their conditions to be readily detectable. That’s not always the case without a thorough history and physical. Often times, more information is needed. Even if you could accept that fact (and overcome that you’re in discomfort), you expect the doctor to recognize the degree of pain and get your appointments moved up or done right away. Why doesn’t the doctor realize that you need to have things done rapidly? You can bet that if it were him, he’d get these things done quickly.

One woman told the doctor her entire list of symptoms. He thought she was a hypochondriac because she listed every one of them (she had been given this list of symptoms by another physician but she didn’t say that). He told her she could have one of two conditions – low blood sugar or low thyroid. She said “which one is easier to treat”. He looked at her funny and answered “thyroid – at least for that you only need to take pills.” She thought for a brief second and then replied “ok, then I’ll take that.” Needless to say, he was dismayed.