Doctor-Patient Communication: When Things Go Wrong

Changes in the health care system have put increasing pressure on patients, their families, and medical caregivers - especially physicians. Doctors are dealing with:

• Ever more complex patients - despite advances, there are still patients who we cannot help as much as we desire.
• More choices regarding treatment options.
• New rules enacted to ensure patient privacy.
• The need to generate clinical revenue.
• Concerns about litigation.
• A greater sense of responsibility to one's own family and children than physicians from previous generations.

While the vast majority of physicians are able to deal effectively with these challenges as a professional, on occasion, these or other issues may combine to take their toll on doctors and be expressed to patients in what may be considered as unprofessional behavior.

Some examples of unprofessional behavior may include:

• Arrogance or disrespectfulness.
• Evidence of prejudice with respect to race or gender.
• Unacceptable abrasiveness or rudeness.
• Terse and unsympathetic pronouncements with regard to prognosis.
• Strategic absence in the face of a worsening illness (abandonment).

Several considerations ought to drive your decision-making:

1. Although it is not entirely an acceptable, your doctor may truly be having a bad day if the behavior that you experienced is unusual. No action need be taken under these circumstances.
2. An assessment of the urgency of your medical situation, especially if in the hospital. In the face of a serious illness, you may want to take swift action.
3. Whether you have lost confidence in your physician's medical decision-making.
4. Repeated episodes of unacceptable interactions.

There are several options available. Pursing them may be a little anxiety-provoking, but doing so may be needed in order for you to have peace of mind knowing that you did the best you could for yourself or your loved one.

1. If working with a hospitalized patient, ask to speak with a patient ombudsman/advocate and lodge your complaint with that person. He or she may then address your issue with the chief of staff, vice president for medical affairs or the president of the hospital. If you want to change physicians, these people are the best equipped to assist you. One of your nurses will have this information and will direct you.
2. If you have a good relationship with your family physician, he or she may be willing to either give feedback to the doctor with whom you are having difficulty or may be able to help you select a replacement physician.
3. If the problem occurs in the context of office visits, you may simply request to be assigned to another physician at the clinic where you seek care.
4. As many if not most physicians are now employed, there is likely a medical director at their clinic and/or a chief executive officer who is responsible for handling these kinds of issues. They may be in a better position to give your doctor feedback on how his or her behavior affected the care they were providing and help you with any transition. Patient satisfaction is very important to all clinics.

The good news is that studies show that most patients have a great deal of respect for their personal physician that is well-deserved. Most medical schools also have formal education programs designed to improve doctor-patient communication in an effort to teach students how to better interact with patients and their families. In the hopefully rare circumstance when the respect that patients have for a physician is breached, confidence in the care provided by the doctor may be shaken and changes may be necessary.

Fortunately, there are options available to make sure that you or your family member is getting the best possible treatment available.

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