Self-Advocacy in Medical Care

Written By: Jonathan Acquaviva, Medical Psychology Center Intern, Southern New Hampshire University

​Although the U.S. has the most expensive health care system in the world, the nation ranks lowest in terms of “efficiency, equity and outcomes,” according to the 2014 Commonwealth Fund Survey 2014.  Given that a typical patient visit usually lasts anywhere from 8-15 minutes, it is hard to cover all that is happening medically (Fricchione, 2014). In addition, patients have more and more specialized care, however research shows that patients feel less and less cared for. That is, generally the days of personal relationships with physicians may be coming to an end.  One possibility of  a counter movement is the development of the Accountable Care model.  Its basic thrust is the movement away from fee for service payments and towards  reinforcement to the physician or hospital for better care based on better outcomes. The intent of this brief communication is to acknowledge how the typical doctor visit has progressed in light of this trend towards disenfranchisement over the years, and to encourage patients to discuss matters with their physicians that they may not consider appropriate despite the lack of time or feelings of empathy.

It has been a common practice for physicians to seemingly not empathize with their patients for a significant amount of time. In fact, there may have been instances where such an approach was encouraged for the sake of objectivity. This can be further illustrated by the literature of Dr. William T Branch Jr from the Department of Medicine at Emory University. While being trained as a physician in the 1960’s, Dr. Branch recalls being taught to maintain distance from patients in order to seek objectivity. In contrast to our encouragement, physicians did “not much respect their input into decisions affecting their own bodies”, in regards to the patient (Branch, 2014).  
 
One of the key elements of Freudian psychology is the role stress has on the individual’s life, both psychologically and physiologically. Stress transcends all fields in medical care. In addition to psychological diseases, stress can manifest itself in forms of diseases such as cardiac disease, chronic respiratory disease, diabetes, arthritis, and other neuropsychiatric disease (Fricchione, 2014). Given the nature of a typical fifteen minute appointment, there is not much a physician can do for the sick individual.  Often times, the results are simply a slowing of progression of the disease which may still lead to suffering and higher levels of stress; stress that may not be actively discussed with a physician. It is not to say that a healthy relationship between physician and patient will alleviate all medical symptoms, however there is evidence that this healthy relationship can promote better outcome.

However there is research demonstrating that  this lack of connection does negatively affect treatment. US government surveys of 5100 family physicians were reviewed and it was concluded that during the typical 15 minute visit, only 3% of the sample doctors reported discussing stress management, 17% provided nutritional counseling and only 12% provided exercise advice. Ideally, these percentages should be higher.

Being social animals, human beings rely on relationships for their most productive interactions. One key element of relationships is respect. If a patient feels respected by his doctor, there may be a better chance to develop a relationship which in turn, should elicit a more productive meeting. Research from the University of Bristol illustrates this notion. The researchers acknowledge there has been little research on the effects of respect of doctors on patient outcome. The study consisted of role play in which participants played the patient and the doctors while following scripts. The results showed that patients felt more respected when the doctor displayed a more respectful demeanor. In addition, higher patient satisfaction was also reported as well as adherence to the doctor's’ advice, and the likelihood of visiting the doctor again. Lower feelings of hurt, higher self esteem, and lower perceived illness identity was also reported. Therefore, it can be concluded that respect from doctors can result in a more productive, positive experience, despite how brief patient appointments usually are (Clucus, & St. Claire, 2010).

Given the likely positive effects of having a positive relationship with a doctor, it is highly encouraged that patients take the initiative to talk to their physicians about more concerning personal issues. There are absolutely physicians currently practice with a more humanistic approach.  What we at MPC are advocating is that whatever your relationship with your physician, and ideally it is a good one, that you will benefit greatly by advocating for your wellness.   The patient’s “job” is to demand the attention to his or her needs in a clear and concise manner so that the physician can best respond to his or physical needs.

References

Branch, W. J. (2014). Treating the whole patient: Passing time‐honoured skills for building
doctor–patient relationships on to generations of doctors. Medical Education, 48(1),.
67-74. doi:10.1111/medu.12369

Clucas, C., & St Claire, L. (2010). The effect of feeling respected and the patient role on patient
outcomes. Applied Psychology: Health And Well-Being, 2(3), 298-322.
doi:10.1111/j.1758-0854.2010.01036.x

​Nerurkar, A., Bitton, A., Davis, R. B., Phillips, R. S., & Yeh, G. (2013). When physicians  
Counsel about stress: Results of a national study. JAMA Internal Medicine, 173, 76-77