Doctors & Patients: A Collaborative Relationship

Fibromyalgia

Fibromyalgia (Photo credit: Kindreds Page)

When I developed my chronic condition the first thing that happened to my life was that I started spending a lot more time in my doctor’s office. So much time that I thought I should be collecting frequent flyer points towards a free office visit. Or I should be given my own examining room with a recliner, a stereo system, and wet bar – and stocked with my favorite magazines. The nurses kept telling me they were working on it in the basement. What I received was a lot of time to read novels while I waited and time to think about this relationship that was forming. Through these frequent visits we learned how to work together and formed an excellent working partnership. In a series of posts I will be sharing with you what I believe made our relationship work so well and especially what it was about the relationship that contributed to my healing.

Originally I had written a section on what patients need from a doctor and then another section on what patients need to take to the relationship. As I was editing them for posting I realized that our relationship worked because we each brought complimentary qualities, knowledge and skills. We were collaborative partners with a shared goal of controlling my symptoms and increasing my functioning. According to Robin DiMatteo,[i] patients are most satisfied with partnerships rather than authoritarian control by the doctor because partnerships allow us to participate more in healthcare choices, leading to more informed decision making, better follow through and adherence to the treatment plan, and ultimately better health and quality of life.

From the very beginning it was important to me that our relationship involved a two-way sharing of information. I definitely needed the knowledge my doctor brought based on his medical training and practice wisdom. His knowledge of drugs was especially helpful as we started trying different medications that needed to be monitored and modified repeatedly. It was useful that he had some experience with treating people with fibromyalgia, not because it helped him know what would help me but, more importantly, that he believed I could get better. He told me he knew one of his fibromyalgia patients was getting better when she told him she was going water skiing. This gave me hope.

I appreciated what he brought but I also brought information to our working relationship. Most importantly I brought information about what my body was doing and how it was reacting to the treatment plan we were implementing and then fine-tuning. I kept detailed notes and made lists of questions or problems I was having. I kept charts of pain levels and fatigue. I recorded blood pressure when that became problematic. He used the material I brought in and he heard and respected what I said to him – and he never discounted my discomfort.

This was eight years ago and scientists where just beginning to research what was happening in the bodies of people with fibromyalgia and the effectiveness of various treatments. I used the National Fibromyalgia Association web site to find new research articles. I highlighted, so he could scan quickly, portions that I thought were especially useful or that I wanted him to take note of. I knew he read these articles because he would incorporate what he learned into my treatment plan when appropriate.

Another aspect of our collaborative relationship was that we both knew that we needed to share the short time that we had together during the office visit. Comment from Dr. Taylor: Sharing our time commitment means that you recognize that every visit can’t deal with every issue. It takes time to relay your symptoms through the fog, time for me to hear, process, understand, suggest a diagnosis and solution. I found I could get the most from our shared time by learning as much as I could about various treatment options. I research treatments and drugs on web pages such as WebMD, Mayo Clinic, and National Fibromyalgia Association. Because my doctor didn’t have to spend as much time explaining things, we could use the time to discuss how these treatment options could meet my unique and specific needs. It is only when all the significant information is put on the table, by both the doctor and the patient, that collaboration can take place to determine which treatment options have the greatest likelihood of working and most importantly treatment decisions are made that we will be able to follow through on.

A very important factor in having a collaborative partnership with a doctor is involvement with our thinking as opposed to our emotions. We need to be actively involved instead of being passively involved. I was speaking with a doctor who had eye surgery and asked him if there were any surprises for him when he became “the patient.” He said he was very surprised how passive he became at the time of the surgery, giving up the decision making to his wife. Doctors recognize that when a person becomes sick they seem to revert to a more passive nature than they would normally take when well.[ii]

The medical community uses the phrase “emotional regressing” to describe the tendency to become overtaken by our emotions and feeling childlike in our sense of helplessness. If we want to collaborate in our health care decision-making we need to engage the thinking parts of our brains when problem-solving with our doctor and only express our emotional pain and fear when we are unable to engage in problem solving because of them. If our emotional pain is pervasive it is more efficient and useful to engage a mental health professional, who is trained to help with emotional issues, as a part of our treatment team.

[i] DiMatteo, R. (2004). Doctor-patient communication. In N. B. Anderson, Encyclopedia of Health & Behavior (pp. 261-265). Thousand Oaks, CA: Sage Publications.

[ii] Salole, R., Stiggelbout, A. M., & Kiebert, G. M. (1997). A role for the sick role/response. Canadian Medical Association, Journal, 157(10), 1349-50.

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