Thursday, April 10, 2014
If you become sick in the middle of the night, you might wake up your spouse, or even let work know you won't be coming in the next day. But some people — at least, those with particularly good relationships with their doctors — might send a quick email over to their physician to let them know what's going on. This sort of interaction may be part of the reason why patients who have good relationships with their doctors tend to have better health outcomes, as a new study found.
Logically this makes sense, as people who get along with their doctors are more likely to go and see them, be honest with them, and listen to their advice. The research, conducted by doctors at Massachusetts General Hospital and published in PLOS One, analyzed 13 randomized control trials, in which doctors underwent training to improve how they interacted with patients. If the doctor-patient relationship improved, the patient's health also improved, for example, by increased weight loss or lower blood pressure. In fact, the researchers said the overall improvement seen across the 13 studies was equivalent to to the added boost that taking aspirin daily has on your risk of having a heart attack.
“Although the effect was small, it’s not smaller than other interventions [like taking aspirin] that are widely prescribed,” said study author Helen Riess, MD, director of the empathy and relational science program at Mass General. 
That a good doctor-patient relationship can improve health outcomes has been shown before, for example in a study that showed diabetic patients are more successful at monitoring their blood sugar when their doctor is more empathetic, said Rodney Tucker, MD, chief experience officer for the University of Alabama at Birmingham Health System who was not involved in the study. Tucker said the finding is "common sense."
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While Dr. Riess and her colleagues are working on ways to effectively train doctors to have better relationships with patients, remember that it’s a two-way street.

10 ways improve your relationship with your doctor:

1. Prepare for your appointment. It’s more than just getting to the office on time. You should also bring all of your current medications (over-the-counter or prescription) to your appointment, along with notes about key facts like whether you've gotten a flu shot at a health clinic, Dr. Tucker said.  Write down any recent health problems or concerns that you have beforehand, so you make sure to bring them up.
2. Prioritize your problems. It’s true that doctors tend to be pressed for time, but that doesn’t mean you should modify your needs to fit within a 30-minute window, said James Tulsky, MD, chief of palliative care at Duke University School of Medicine. Make a list of the things you want to address, and let your doctor know how many things are on it at the start of an appointment, Riess suggested. Ask how many items on your list your doctor can get to today, and if they’re not all addressed, talk about making another appointment, she said.
3. Don’t just share the chief complaint, share the chief concern. It may seem more natural to simply tell your doctor about a specific problem you’re having — pain in your knee, for example. But it’s equally important to share what your main concerns about it are, Riess said. Your concern might be about whether you need to have surgery for your knee, because surgery worries you, or because you’ll need someone to watch your kids. If you don’t share your concerns, your doctor can’t respond to them, and remember — doctors are trained to address your concerns, too.
4. Make sure you leave with the information you need. It can be hard to speak up in a doctor’s appointment to say that you don’t understand how to take a medication or what you need to do to follow up. “It feels like you’re interrupting,” Tulsky said. But when you leave the office, you become responsible for your care, so you need to make sure all of your questions, including emotional concerns, are met. Tulsky also noted that research shows that doctors respond more strongly if a patient brings up a question twice.
5. Record your visit, or bring someone to take notes. There’s often a lot of information to absorb during a doctor’s appointment, particularly if you’re facing a major, frightening health challenge. You may be distracted by trying to take in a diagnosis, so it can be helpful to bring along a spouse, friend, or family member to take notes and ask questions, said David Longworth, MD, the chairman of the Cleveland Clinic’s Medicine Institute. Alternatively, you could record your visit so you can refer to the information later, Tulsky said — just make sure you ask your physician if that’s all right.
6. Ask how to reach your doctor after hours. Every doctor will have a different preference, and some offices have systems set up, so it’s important to ask your doctor how you should be in touch in the event of a medical problem that happens outside of regular hours. If you know the system for getting in touch in advance, that’s one less thing to worry about when you’re actually facing a medical crisis.
7. Learn how to use electronic health records. EHRs shouldn't just be for doctors — the new electronic health records should be making it easier for you to manage your care, too. Find out if your doctor’s office is using EHRs, and figure out how you can use the access portal, too. Signing up to use EHRs allows you more access to your records and educational material, Tucker noted, and provides you with a secure system for emailing your doctor, Tulsky said.  
8. Tell them if you’ve gone to another doctor. Whether it’s a specialist, an emergency care situation, or an appointment you had to schedule on a day that your doctor was out, it’s important to make sure your main doc is in the loop about the other medical care you’ve received. EHRs make it easy to share information if the doctors are in the same system, but always make sure to ask that a record of the visit be sent to your primary care doctor. Carrying your doctor’s card, with the relevant contact information, will make doing this a breeze, Tucker advised.
9. If your doctor isn't meeting your needs, bring it up. It can be hard to tell your doctor that there are certain parts of your care that you think are lacking, but all four physicians said it’s important that you do so. “Sometimes they just need to be told ‘this isn’t working,’ and they will try very hard to fix it,” Tulsky said.
10. Find another doctor. If you’ve brought up the problems you’re having with your doctor and nothing seems to have changed, you should feel free to find a new one. “This is all about having confidence and trust in someone that you’re entrusting your life to,” said Dr. Longworth. If you have any doubts about your doctor’s clinical competence, or you just don’t feel like you have a good relationship, look elsewhere, Longworth said.