Hippocrates is credited with the saying: “If there are several doctors, one of whom heals with herbs, the other with a knife, and the third with a word, first of all turn to the one who heals with the word.” And the truth – there are doctors, from a conversation with that, even before the implementation of what some prescribed recommendations, is already becoming easier and emotional state improves. And it happens that exactly the opposite happens and communication with a doctor turns into torture. Let’s figure out what these doctors are doing wrong.               

The doctor does not see you as a partner

In the early 1980s, the American bioethist Robert M. Witch identified four models of the doctor- patient relationship . Within the framework of the “engineering” model, the patient is perceived as an impersonal mechanism, and the doctor’s task turns into fixing the breakdown. The patient is completely excluded from the discussion of the treatment process. In the “paternalistic” model, the doctor- patient relationship is similar to the mentor- ward relationship . Even if there is a place for compassion and mercy in it, it often turns into an authoritarian position of the doctor and almost unconditional submission of the patient to decisions that the doctor makes alone.

If you have entered into an agreement with a medical institution (directly or through an insurance company) and each party bears its own obligations and receives its own benefits, we are talking about a contractual (contractual) relationship with a doctor. The interaction between the doctor and the patient in this case is strictly regulated by the contract. 

And only the collegial ( aka partnership) model is based on the principle of equality. The doctor provides the patient with complete and truthful information about the diagnosis, treatment methods, possible complications and consequences of the disease. The patient is involved in discussing this information and making decisions about his condition. In this model , the patient has freedom of choice.         

The doctor and the patient together choose from possible treatment options, even if difficulties arise. For example, if a therapy is selected to control blood pressure, and the doctor prescribes a combination drug with a diuretic component. The patient says that he cannot take it, because he works as a cashier and is afraid that he will not be able to leave the workplace often – then, together with the doctor, they decide on another drug.

The doctor does not communicate with you

Research shows that patients who trust their doctors find it easier to treat and prevent chronic diseases. The patient, in fact, participates in his own treatment, and the task of the doctor is to provide him with sufficient information.  

For example, the autoimmune disease diffuse toxic goiter (caused by hypertrophy of the thyroid gland) can be treated in different ways: with pills, surgery, or radiation therapy. The doctor tells the patient with this diagnosis all the options and discusses what is preferable in his case, and then the patient makes his own decision.

A good doctor should explain to the patient the plan of treatment, prescription of medications, and, if necessary, recommendations on the regimen and diet. In addition, the doctor must answer all questions – about the disease, treatment tactics, possible prognosis of the disease, comment on each proposed solution. A good doctor will always explain what is happening, reveal incomprehensible terms. If the patient doubts that he has memorized everything, the doctor should write down his prescriptions and recommendations. Ideally, after any visit to the doctor, we should come out with a written opinion. 

Signs that the doctor is not building a dialogue with you are very simple. Such a doctor does not allow you to speak, he often interrupts. He did not respond to direct questions about your health, do not explain why it offers , or other diagnostic and therapeutic purposes. Such a doctor actively uses and does not decipher incomprehensible medical terms and concepts. It doesn’t give you the ability to make decisions for yourself. Doesn’t ask “What course of action would you like to take?” or ignores your comments on this topic (“I would like to discuss decisions about my health”).                   

The doctor ignores your needs

If we go to the doctor in order to resolve the issue of hormonal contraception, and we are offered to have a child instead, or we come with a splinter in a finger, and the doctor advises us to reduce body weight , this is an eloquent, frank and unacceptable violation of the rules . Even if a doctor has his own ideas about life, he should not express anything other than the real provisions of evidence-based medicine. And then only in response to a direct question.    

Of course, a person without medical training, some questions may not seem relevant to the case or to the primary physician specialty, and sometimes tactless. Although in fact they are quite normal: the doctor must take into account everything to the smallest detail and pay attention to details that are not necessarily obviously related to the patient’s complaints. It happens that patients and patients are confused by issues related to weight, menstruation, pregnancy and abortion, sex life. This is due to the fear that they are not “the norm”, or because of the indelicacy of the doctors with whom they had to deal with before.            

The doctor can ask us questions about the state of health, habits and lifestyle, history of the development of symptoms, concomitant diseases and medications that we take, ask about cases of diseases among the closest relatives: parents, grandparents, siblings . These many questions should be treated with patience and understanding.          

However, this does not mean that absolutely any question will be acceptable. If you have the feeling that the doctor is outside the scope of your request, you need to indicate this. After all, it may turn out that tactless questions are asked simply out of curiosity. For example, intersex people and trans * people are often asked about the structure of their external genitals or the details of their sexual life.        

The same goes for recommendations: they should be based on our request. If the doctor does not offer solutions to the problem with which you came to him, or persistently suggests that you deal with the issue that does not bother you, he is violating your boundaries.    

The doctor violates your bodily boundaries

The doctor is obliged to clarify whether you are ready for certain manipulations, and can not touch you or carry out any interventions without your consent. If you do not understand what the procedure will be, ask the doctor to explain as much as possible to you so that you can give informed consent to it.        

Yes, any medical appointment must include an examination. But the patient does not always need to undress and lie down on the couch. For some specialists, to assess the condition, it will be enough to assess the body type, the distribution of subcutaneous fat, the condition of the hair and skin and palpate – after your consent – the organs necessary for diagnosis. It is necessary to take into account the patient’s physician comfort and not invaded his personal space without the need, as far as possible pronounces their actions to their implementation and in the time of it.               

In July of this year, an anesthesiologist was sentenced to ten years in a strict regime penal colony in St. Petersburg , who was found guilty of committing sexual violence against female patients. It may seem that this is a nightmarish surrealism from ” Kill Bill “, but this is a real situation, and even in relation to underage patients (at least some of them were at the time of the crime).  

The doctor hurts and discriminates against you 

A relationship with a doctor, like any close relationship, is sometimes abusive, and the violence can be not only physical or sexual, but also psychological or economic. A paternalistic approach, going beyond the limits of an individual request, tactless questions – all these are examples of psychological pressure from a doctor. This also includes being addressed by the wrong name or kind that you have designated as acceptable to yourself.

The doctor should not forget that a living person came to his appointment, to whom you cannot raise your voice, speak rudely or manipulatively with him. All of this is a violation of the patient’s personal boundaries and must, no doubt, be suppressed.

If you get the impression that the doctor discriminates against you on the basis of your race, nationality, gender, sexual orientation, and so on, then this is a reason not only to talk about this with the doctor, but also – if the situation is not resolved – to change him and convey this information to management and even to the public . 

All those situations when a doctor prescribes (of his own free will or because the management of a private clinic requires him to do so) unnecessary paid examinations can be indirectly attributed to economic abuse .

The doctor acts without proof 

A good doctor will not make outdated or commercial diagnoses – diseases that are absent in the International Classification of Diseases or do not actually match the patient’s symptoms, but for which expensive treatment or examination can be prescribed. Also, he will not prescribe drugs with unproven efficacy – unless a healthy person is sure that he is sick. In this case, such prescriptions – harmless, but also useless – work like a placebo, the patient feels better and feels relief from the “treatment.” In parallel with this, as a rule, it is recommended to consult a psychotherapist.                   

All doctor’s prescriptions must comply with international recommendations and be based on the principles of evidence-based medicine. In it are used solely therapies and drugs that have passed clinical trials, that is, those whose effectiveness is scientifically proven.      

It would seem that all medicine should already be evidence-based, but some doctors still prescribe homeopathic medicines, ” fuflomycins “, magnetotherapy and other ineffective, and therefore , in the absence of normal treatment, dangerous methods.      

All English speaking patients should be encouraged to check prescribed medications on good patient sites like UpToDate (search through patient articles is free). If you are not sure about the prescribed treatment or examination, do not hesitate to ask all your questions to your doctor or ask another specialist for a second opinion if you were not able to get a clear answer.            

Doctor communicates unethically with colleagues 

The efforts of one specialist are not always enough to treat a patient – sometimes teamwork is required . And in such a situation, your health will directly depend on how good your doctor is as a team player.     

If the story develops within one clinic, the doctor must give colleagues an outpatient or inpatient medical record containing all information about the patient. And when transferring to another institution – to prepare a detailed extract. Each subsequent doctor complements the data obtained and the treatment results, which allows you to accurately determine the diagnosis and select the appropriate treatment. This interaction provides fast and quality assistance. When transferring a patient, the doctor must ensure the continuity of care: convey information, describe his diagnostic concept or treatment regimen. 

Until now, there is an opinion that a doctor in no case should convey to the patient his opinion about another doctor and his prescriptions (even if he is wrong). They argue that, faced with something like this, a person can lose confidence in any doctors. In Russia, there is no official regulation for a doctor’s actions in a situation when he is faced with the unprofessional behavior of his colleague. It turns out that everyone decides the issue for himself individually: someone will remain silent, even if the appointments of a colleague were not consistent with the evidence-based medicine data, someone scolds colleagues on business and not on business.                    

The second option, of course , is unacceptable: the doctor must be able to work in a team and not be “jealous” of the patient towards other doctors. But and the first not less dangerous. The solution can be neutral commenting on the appointments of another doctor without becoming personal. A good doctor may well make it clear to the patient that the previously prescribed treatment, procedure, analysis are not shown to him.