How should a patient choose a doctor

Doctor-patient conversation : The healing power of the consultation

“She hardly takes time for me.” “He doesn't listen to me.” “She interrupts me all the time.” Such sentences are often uttered when patients tell why they are dissatisfied with their doctors. But there are also complaints from the medical profession: about patients who do not keep agreements and who no longer want to take medication after reading the package insert, who report in lengthy ways about their condition or who sit taciturn in the consulting room. Communication between sick people and their doctors can be difficult - and even hinder effective treatment.

If the conversation does not work, the effectiveness of the therapy suffers

For example, young doctors make less precise diagnoses when they are dealing with “difficult” patients, according to a study by Silvia Mamede's working group from the Institute for Medical Education Research in Rotterdam. 74 interns from different specialties were confronted with various fictitious case histories, each of which spoke in favor of a fairly common diagnosis - from appendicitis and inflammatory bowel disease to acute viral hepatitis and hyperthyroidism. The typical symptoms were found either in patients with friendly and inconspicuous behavior or in those who appeared aggressive, questioned the doctor's competence or annoyed him by repeating the same questions over and over again. The doctors spent about the same amount of time on all patients. Later, however, they remembered the clinical results less well when the conversation was difficult, but they did remember the behavior of these patients. Attention to the bumpy conversation comes at the expense of diagnostic accuracy, is Mamedes' conclusion in the British Medical Journal.

Cancer diagnosis by letter

In the worst case, such conversation situations can even lead to the suspicion that the unpleasant conversation partner has “nothing”. "Efforts should be made to raise the doctors' awareness of the possible negative impact of difficult behavior on diagnostics and to strengthen their ability to counteract this," concludes Mamedes research team. Exercises with actors who slip into the role of sick people today often bring this art to aspiring doctors during their studies.

At the international conference “Putting Patients First”, which recently took place in Berlin, it was also about the continuation of the relationship between the two “sides”. As a patient representative, the Briton Ronny Allan, who has been living with a rare incurable cancer for years, criticized that his final diagnosis had been communicated to him in writing. How one can convey bad news in good, human form has been the subject of advanced medical training events for years ("Breaking Bad News").

Patients organize themselves and participate in the development of therapy

The patient's position has also been strengthened politically and legally. The aim is "joint decision-making" for the individually appropriate therapy. The chronically ill and their relatives organize themselves in self-help groups and become experts and lobby for their own illness. Patient organizations take part in scientific studies and bring the aspect of everyday dealing with their disease with them.

Deutsche Leberhilfe e.V. has participated in several studies on the quality of life, the level of information and the economic situation of patients with liver diseases. From such a study we know, for example, that people with hepatitis C are well informed about their illness, but that they often miss the knowledge and understanding of the people they deal with in their work and everyday life, and that many of them miss them can no longer work and have financial worries. “To take part in such studies or even to initiate them is immensely important,” says Achim Kautz, who is involved in the German Liver Aid.

In his view, it is not least because of their interest in scientific data that patient representatives in Germany are now often represented in commissions that draw up new professional guidelines for the treatment of diseases. “We have significantly more influence here compared to other countries. In England, for example, patient representatives are more involved in decisions about the reimbursement of medication by health insurance companies. "

Kautz sees it as a problem that self-help organizations, which enjoy authority as representatives of the sick, can be influenced by pharmaceutical companies. "All the more important is the role of your scientific advisory board and the rule that you may not be supported by industry more than 40 percent, and if possible by several competing companies."

Both sides have to get involved

The decisive factor for the success of the doctor-patient conversation is how well both “sides” can empathize with each other. For doctors, this means learning from colleagues who got sick themselves and who had to get to know others, the role of those seeking help. But one could also expect a certain amount of the patient's understanding of the doctor's difficulties, said general practitioner Christine Oesterling from London at the conference. So it is very important to report as completely as possible about the symptoms during the first visit so that the doctor can get an idea.

Whoever was asked at this conference: Everyone agreed that there had to be more time for such discussions in practices and clinics and that they should be better rewarded. But time and money are not everything. Rajan Somasundaram, head of the central emergency room and admission ward of the Charité on the Benjamin Franklin campus, also wished himself and his colleagues an attitude of openness. Even and especially if the conversation with a new patient is difficult at first. "The first impression is important, but it is also dangerous to rely on it, so quickly make a suspected diagnosis to which you then assign everything."

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