Aging Begins at 30

Doctor and Patient Dissent

Ian Maclean Smith, M.D.
Emeritus Professor
Department of Internal Medicine
University of Iowa Hospitals and Clinics
Creation Date: January 2002
Last Revision Date: January 2002
Peer Review Status: Internally Peer Reviewed

Why do patients fail to get appointments or follow ups? A third of men and a fifth of women have no regular physician. Many are skeptical of medical claims. Others are not adequately educated to judge what is true. Others are busy or move frequently and never build a doctor-patient relationship. Some are well insured and still don't get check ups. So scared about blood in the stool, or a lump in the breast possibly indicating cancer, some run away from rational investigation. Some mental adolescents in their approach to health, say, "I'm invincible." Some overly believe in the healing power of nature. Annual check-ups are needed from 40 onward.

The fault, as with Betty, may lie with the doctor. I've seen doctors too busy to listen. They cut off the patient's illness story after two minutes. Sometimes it seems easier to order an ECG test than do a proper exam or refer to a specialist. Doctors are being asked to do too much. Because profit-hungry shareholders run some medical companies, too many patients are scheduled. In a recent survey only 30% of patients thought the doctor spent enough time with them.

Great advances in the ability to diagnose and treat many diseases have been made in our lifetime. Despite these advances, patients are trusting doctors much less to cure them.

Recently patients have challenged physicians' knowledge in making plans for the patient. About 25% of patients under 60 do this and only 8% over 60, reflecting old patterns of care. Younger patients are learning more about their bodies and illnesses. Knowledge about illness is less of a doctor monopoly. Reliable information is out there for patients that was not easily available in the past. But misinformation too! We now have a more educated and egalitarian patient population. Patients are willing to challenge the doctor's decisions and have done so since the mid 60s. The knowledge gap about illnesses has narrowed but less so with some esoteric technologies. Patients with past experience of medical errors are frequent challengers. Many read their own records and the weighing of alternatives can be read as criticism. One has to distinguish between what could be done and what should be done.

Only 40% of those age 65 and older fail to visit their doctors, and patients 75 and older average seven visits to doctors compared to the average of four yearly.

What should be done? You need regular check ups. Your physicians are busy, often with paperwork that the payers insist on as they won't take your word that you did a proper history and physical. To be helpful, organize your thoughts and put them on paper. Before your doctor visit list your questions in order of importance. If you go home and forgot something important, e-mail your doctor or telephone the office's nurse. When the day's work settles your doctor will answer you. Doctors with good rapport and detailed records can earn your trust and develop a compliance that you can fully understand and cooperate in.

Personally my last two doctor visits have been satisfactory and enjoyable. I thought he, (my generalist) and she (my neurologist) got my problems straight and provided me with satisfactory answers.

Section Top | Title Page

See related Patient Topics Communicating With Your Health Care Provider, Physical Examinations, Preventing Disease and Staying Healthy, Social/Family Issues or Wellness and Lifestyle.

See related Provider Topics Physical Examinations, Preventing Disease and Staying Healthy, Social/Family Issues or Wellness and Lifestyle.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

http://www.vh.org/adult/patient/internalmedicine/aba30/2002/patientsanddoctors.html