This month’s Ask Kat was inspired by an Infoline caller describing her troubles in managing her rheumatoid arthritis (RA) pain and finding it difficult talking to her doctor about asking for medications to help with her pain.
First – doctor – patient communication
Doctor-patient communication is a fundamental component of clinical practice. A strong therapeutic doctor-patient relationship is key for effective communication and is associated with better health outcomes. However, despite this, good communication remains a challenge for some doctors and is the underlying reason for the major part of patient complaints, and can be associated with poorer health outcomes. The ultimate objective of any doctor-patient communication is to improve the patient’s health and medical care. Studies on doctor-patient communication have demonstrated patient discontent even when many doctors considered the communication adequate or even excellent. Some doctors overestimate their abilities in communication. In the context of orthopaedic surgeons, a study found 75% of doctors believed that they communicated satisfactorily with their patients, but only 21% of the patients reported satisfactory communication with their doctors. Patient surveys have consistently shown that they want better communication with their doctors.
Not every doctor-patient interaction is bad. For example, the relationship I have with my doctor is great. We get along well, he takes the time to listen to me, he lets me question and challenge him (which he probably finds annoying at times!), and if I bring up something he isn’t sure about, he’ll research it for me and we talk collaboratively about options and best treatment methods. However, not all of my experiences have been like this. In the past, doctors often didn’t let me tell the “whole story” or history of my complaint, they were rushed and I felt “bad” taking up their time, and at times I felt a little intimidated so all the questions I had often went out the window. Have you ever felt like this? Or perhaps you wanted to try a different medication, or the one you’re on isn’t working anymore. Or you were given a medication and not directly told about the side effects, only to find out later by some other means.
Your doctor may be rushed and time poor but this is no excuse for poor communication. The therapeutic alliance (i.e. the relationship between healthcare professional and patient) should be client or patient centric, and you and your doctor should be working together towards a healthier future. This means that your doctor should give you an uninterrupted chance to tell your story of pain, complaint or symptoms, instead of only asking a list of yes-no questions. When you next go to the doctors, and you feel your doctor may be rushing you or not really listening, or firing questions at you- politely ask if they could stop and listen instead. When this time comes, ensure are prepared and loaded with questions and information about your health experience. For example, don’t simply say your chest hurts or your knee hurts, provide the narrative- tell the story as best you can:
- When it started
- If it’s been painful before
- What you were doing when it started hurting
- What you were feeling
- How often does the pain occur
- What you think is happening
Second – what if you feel your doctor isn’t listening?
Unless you speak up about your concerns, your doctor may not be aware of the way you are feeling; they won’t know how to better the doctor-patient experience. Why not try some of these tips:
- Be straight forward and honest if you are not being heard, for example, you may say something like, “I’m worried that we aren’t communicating well. Here’s why I feel that way…”
- If your doctor is making you feel rushed, you could say… “I know you’re busy but I’m not feeling good about X (treatment decision, or medication etc). Can we talk about this further? Can we make a time in your calendar?”
- If your doctor uses big words and medical jargon, and you don’t understand, don’t just sit and nod- speak up. You could say something like… “I don’t understand. Can you please explain it so I understand it better”
- Bring a friend or family member to help advocate for you, ask questions for you or help you understand. They may give you the confidence to assert yourself
- Ask about the best way to contact your doctor with other questions
- Give feedback about your doctor’s care
- Have a “teach-back” moment so you fully understand what your doctor has directed you to do. You could say something like… “I want to make sure that I have it right- so you want me to do this, or take X medication for X long, or you want me to monitor this and then book back in…” This ensures you and your doctor are on the same page and provides an opportunity for further direction and clarification.
Third – specifics about medications and doctor-patient communication
As a patient, it’s your right to understand everything about a medication prescribed for you. No, this doesn’t mean you have to become a doctor or pass some test, it simply means that your doctor should be taking the time to explain why they have selected this medication for you, how it works, raise the potential for side effects and any additional drug interactions (i.e. they should be double checking what other medication you are on) and when best to take it.
Your doctor has your best interest at heart and will prescribe the best medication for the job. Doctors are guided by many principles, protocols, clinical guidelines and evidence when it comes to providing treatments and medications. As a patient, you need to understand that 1) your doctor will likely (this is a generalisation) start you on a drug that is more commonly prescribed (e.g. paracetamol) for the condition before prescribing a more targeted or complex drug (e.g. methotrexate) and 2) everybody responds differently to different drugs. You can’t compare yourself others. Your dose may be lower or higher than your neighbour, or you may experience none or all of the side effects and this is why your doctor may change dosages or change the medication completely. Regardless, the point is, it’s important to understand the medication prescribed to you. To help you do this, you may like to ask the following questions:
- Do I need this medicine? Are there alternatives?
- How will it impact my body- what are the side effects?
- What control do I have over the effects of the drug?
- Is there are cheaper/generic option?
- How long should I be on this?
- Is this drug addictive? Will I build a tolerance? If so, then what?
- I’m also taking X, Y, Z medications, are there any interactions?
In focus – talking with your doctor about pain medication
Pain is a common yet complex symptom of many, if not all, types of arthritis. Recently, I was talking with someone who called our info line about the troubles they were having with managing their pain and asking their doctor for medications. An all too familiar story started to unfold; this particular lady had RA and all the over the counter medication (such as paracetamol and ibuprofen) just weren’t doing the job anymore. She asked her doctor for something more or different, in particular, she asked for a medication containing codeine (because of past experience she knew this worked). Her doctor said no and didn’t really offer an alternative to help with her pain. Now, there are a few things to consider in this particular scenario:
- Firstly, it’s OK for the doctor to say no, and there may be reasons beyond our instant awareness for why they have made this decision. However, to encourage patient understanding and autonomy, your doctor should justify their decision with an answer and if they can, and should discuss/offer alternative medication or treatment.
- The reason a doctor may say no, in this case to codeine, is because drugs that are from the opioid family are highly regulated due to associated high addiction, overdose and death rates. Codeine is an opioid, and while it’s the weakest of the bunch, it really only acts as a band-aid; it only masks your pain and actually doesn’t fix the problem. The likely rationale for doctors not prescribing codeine or other opioids is because of the band aid effect and the risks of using opioids outweigh the benefits. Essentially, your doctor may decide it’s better for you long term not to engage in opioid usage.
If your doctor says no to a particular drug, it’s OK to ask why. It’s also OK to speak up and ask for an alternative medication or treatment (e.g. non-medication based approaches like meditation and mindfulness, exercise etc.). Be aware that different classes or groups of medications have different side effects so ask about them. Remember, doctors are only human and can run late. They are also bound by many guidelines, procedures, restrictions, and reporting protocols. With this in mind, you still need to feel you are being listened to and feel your doctor has explained “X” thoroughly enough.
I hope this blog has provided you with some understanding about why doctors may make the decisions they do and, importantly, practical tips on how to be heard by your doctor.
- Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: a review. The Ochsner journal, 10(1), 38–43.
- Kee, J. W., Khoo, H. S., Lim, I., & Koh, M. Y. (2018). Communication skills in patient-doctor interactions: learning from patient complaints. Health Professions Education, 4(2), 97-106.
- Shoemaker, S. J., & Ramalho de Oliveira, D. (2008). Understanding the meaning of medications for patients: the medication experience. Pharmacy world & science: PWS, 30(1), 86–91. https://doi.org/10.1007/s11096-007-9148-5
- How to talk to your doctor about medication. Posted By Carolyn A. Bernstein, MD, FAHS On April 23, 2018 @ 10:30 am. In Drugs and Supplements, Health, Health care. https://www.health.harvard.edu/blog/how-to-talk-to-your-doctor-about-medication-2018042313696