It seems to me that many healthcare organizations assume that doctor/patient encounters are transactions between equals. Much of the healthcare organization language reflects this idea. Doctors and nurse practitioners are called ”providers.” That is supposed to be inclusive language, but rather than that, it characterizes doctors or nurse practitioners as providing something (health care) to consumers (patients). While empowering patients is a laudable goal, characterizing the clinician-patient encounter as similar to selling shoes is not. I prefer the term clinician, which includes doctors and nurse practitioners.

I want to be clear that I am not advocating for a return to the paternalistic (perhaps authoritarian is a better word) model of “Doctor knows best.” This kind of relationship, where the doctor decides what the diagnosis is and what the treatment will be without regard for patient’s preferences or values is disappearing (although not fast enough) and good riddance to it.

On the other hand, there is an inherent asymmetry of power in relationships between clinicians and patients and pretending that it does not exist will not make it go away. When patients are ill, frightened that something bad may be wrong with them, they do not comparison shop. They go to a clinician they feel like they can trust to help them. A good clinician provides the best science in diagnosis and treatment tailored to this particular patient; her values, her preferences, her personality.

Empowering patients

Good clinicians empower the patient as much as possible. They do this in several ways. They listen carefully as I discussed in the previous post. They create a partnership with patients. As one patient said in one of my interviews, “one thing I really appreciated with [my doctor] is like we’re a partnership.” 

Good clinicians also empower patients by translating medical jargon into understandable language and by giving them information they can use to manage their own illness. As one patient said, “He explained what I needed to do going forward, the life change it would take, you know the medication, the eating habits, and everything to try and keep it from happening again.”

Using clinician power

Sometimes, clinicians need to carefully use power to push resistant patients to take actions that are important for their health. As one patient with HIV infection said, “…that’s why I really need, someone to push me, tell me you have to do those things. That’s one of the reasons that I’m still here.”

Good clinicians have an intuitive understanding about when and how to push patients based on assessments of patients’ needs and strength of relationships. One physician described it this way: “…sometimes you’re the coach and sometimes you’re the boss and sometimes you’re the sibling and sometimes you’re the doctor.”

What to look for in your doctor

Here are some red flags that suggest you should look for another doctor.

1. Your clinician has already made up her mind about treatment and pays no attention to your concerns.
2. Your clinician lectures you about your bad health habits
3. Your clinician gives you whatever medicine you ask for that you have found on the internet without discussion of whether it is appropriate for you.
4. Your clinician uses medical jargon that you don’t understand.

There are good clinicians out there that know how to use power appropriately in the context of relationship. Most of the time that means empowering patients, but it also means knowing when to push when necessary for the patient’s benefit. If you don’t have one like that, keep looking.