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More PsychNotes: Policies and Issues in Mental Healthcare

November 16, 2015       

When Doctors Don't Listen
by Monica A. Frank, PhD

doctor and patient
Have you ever had a medical situation where you understood your body and what you needed better than your doctor but the doctor wouldn't listen to your needs? Unfortunately, such scenarios happen too often. A particular issue for many people with mental illness is that physical complaints or anxiety about medical treatment is viewed by health professionals as part of the mental illness and not taken seriously.

Even in situations where guidelines exist for the medical professionals, communicating the proper information can sometimes be difficult. My husband, for instance, couldn't get medical staff to understand his serious adverse reactions to certain medications so he just started listing them when asked, “Are you allergic to any medication?” even though he wasn't technically allergic to the medications. By doing so, however, the staff seemed to understand but usually didn't follow-up for more information. Best medical practices indicate that the question about allergies should include “adverse reactions” as well as determining the type of reaction (Lyons, et al., 2015).

Interviews with diabetics educated to self-manage their disease showed that many had difficulty explaining their training to doctors who wanted to handle treatment differently especially when hospitalized. Diabetics who know how to manage their blood sugars wouldn't be allowed to self-control in the hospital (Snow, et al., 2013).

In our health care climate today, doctors are overworked with more documentation demands so it seems that the aspect of patient care that suffers is truly listening to the patient. As a psychologist examining the report regarding diabetics' communication with their doctors, I concluded that more attention to assertively communicating their needs could have helped improve the interactions. Certainly, it would be best if medical professionals were better trained in collaborating with patients, but patients need to be prepared when the ideal situation doesn't occur.

Assertive communication isn't just stating your needs. Instead, it is more important how you state your needs. The following guidelines may be useful when you know your needs better than your doctor. I realize that when you are not feeling well it may be hard to change how you communicate, so it may be a good idea to practice assertive communication generally so that you are prepared in medical circumstances. Or, have someone who can assertively advocate on your behalf.

1) “I” statements. Explaining from your own perspective is much more effective than focusing on the doctor's perspective. Even when being very gentle in your approach, a “you” statement tends to increase defensiveness and cause the other person to become more entrenched in their position. For instance, “I find that when I do (this) it works well for me” is more likely to be heard than “Your plan won't work.” Or, “I'm concerned about my reaction to this medicine” rather than “You don't understand...”

2) Stay positively focused. Try to express your concerns or requests in a positive way. For instance, rather than refusing treatment: “I want to fully understand my options to determine which treatment is best for me.” Keep in mind that physicians are obligated by law (at least in the U.S.) to clearly explain your alternatives and you have the right to make the decision. This is referred to as “informed consent” and most people are familiar with it when it comes to surgery or emergency care. However, informed consent is a factor in all healthcare decisions even in your doctor's office.

3) Don't make accusations. When you make accusations the other person is likely to become defensive. When a person is defensive the focus is more on protecting themselves than on listening to your needs. How you word something can determine whether you are heard or not.

4) Remain firm but calm. If the above suggestions don't work, stay firm in communicating your needs but remain calm. When you lose emotional control (and I know such situations can be very frustrating) you are less likely to be heard. To remain firm you can use the “broken record” technique which is just continuing to repeat your message: “I control my blood sugars very well by doing ____.” In addition, you can say “no” firmly but calmly: "No, I don't respond well to that treatment."

5) Issue of non-compliance. Doctors can dismiss you from their practice for non-compliance and some physicians are too quick to use that term. For instance, they may make a recommendation for treatment but then accuse you of non-compliance because you ask questions about alternatives. This is not in the spirit of informed consent. Know what your rights are. You have the right to refuse treatment (except for a few circumstances). If you are concerned how your doctor may label you in the records, you may need to assertively request to review your records which is a patient right in the U.S. Not only can you review your records but you can request that notations be made regarding inaccuracies. For instance, if you are labeled non-compliant, you could ask that they indicate “Patient states this term is inaccurate as she simply requested information regarding alternative procedures” or “Patient believes he is compliant but is adversely affected by the medication and cannot use it.”

Lyons, N., Rankin, S., Sarangarm, P., Washington, C., Weiss, S.J., and Ernst, A.A. (2015). Disparity in Patients' Self-reported and Charted Medication Allergy Information. Southern Medical Journal, 108, 332-336.

Snow R, Humphrey C, Sandall J. What happens when patients know more than their doctors? Experiences of health interactions after diabetes patient education: a qualitative patient-led study. BMJ Open 2013; 3:e003583. DOI:10.1136/bmjopen-2013-003583

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