Can Long-Term Physician-Patient Relationships Be Bad For Your Health?

I wonder how many problems like non-compliance, usually attributed to “poor patient behavior,” actually stem from long-term physician-patient relationships in which both parties have just given up?

You know what I mean…physicians who have treated certain patients long enough that they believe they are just plain never going to do what they are told…and patients with expectations for care and service from their physician that never seem to be met.

I wonder how many problems like non-compliance, usually attributed to “poor patient behavior,” actually stem from long-term physician-patient relationships in which both parties have just given up?

You know what I mean…physicians who have treated certain patients long enough that they believe they are just plain never going to do what they are told…and patients with expectations for care and service from their physician that never seem to be met.

Like any long-term relationship, people become used to one another and develop coping mechanisms to avoid an outright breakdown.  People in long-term become complacent with one another’s “quirks.”   We are all too willing to settle for the things as they are and not push the boundaries of the relationship hoping to improve it.

But there is a long-term cost to the patient and physician when we ”settle” and try to just get by as the graphic below suggests.

At face value, most physicians and patients don’t do a great job when it comes to communicating with one another.  Take patient expectations .

Most people have certain basic  expectation for what we want to happen when we consult our physician.   At a minimum we expect to have the time and opportunity to tell the doctor why we are there.   After all, if we are concerned enough to make an appointment we want to be heard.  Maybe we also have an expectation for a specific service – say a test, a referral or a new medication.

Quite often however, patient’s expectations, reasonable or not, often go unmet.  According to researchers, physicians failed to ask for patient’s full reason for their visit in 77% of visits.   Maybe the physician has little time to allow the patient to ramble on or maybe the physician has already arrived at a diagnosis already.

The reality is that the patient’s expectations were unmet perhaps resulting in disappointment and perhaps frustration.  Unfortunately, as Avedis Donabedian, MD, once said, “patients are overly patient with their physicians” and are willing to put up with a lot without saying anything (or reporting it on patient satisfaction surveys).

Not every patient’s request for a test, referral or medication is appropriate.  Physicians have an obligation to deny inappropriate patient expectations.  But again, depending upon how well the physician explained their reasoning for the denial, some patients will be disappointed and perhaps even angry.   Another study found that 56% of patients expressed an expectation for a specific service – a test, referral or medication… with 50% not getting what they asked for.

Now imagine playing this scenario playing out between patient and physician 2 or 3 times a year over a number of years.   I have to believe that in situations like this patients continually lower their expectations of their physicians…and along with it their trust, willingness to share information, and a willingness to comply what the physician recommends.  Physicians for their part probably reciprocate these feeling in some way.

The point is that settling and being complacent can be bad for the patient’s health and very unsatisfying for the physician.   Too bad we don’t measure patient and physician complacency…it could probably explain a lot.

That’s my opinion…what’s yours?

Sources:

Dyche, L. et al.  The Effect of Physician Solicitation Approaches on Ability to Identify Patient Concerns.  Journal of General Internal Medicine. 2005; 20:267–270

Peck, B. et al.  Do unmet expectations for specific tests, referrals, and new medications reduce patients’ satisfaction? Journal of General Internal Medicine, 2004; 19(11), 1080-7.