Partners in Health
Eight ways to be your doctor’s ally in your care

Tim Johnson

Few Canadians would dispute that our health-care system is under heavy strain—that’s clear every time we take a seat in an overflowing waiting room. Even so, physicians are working hard to deliver the best care possible, a fact not always recognized by patients, some of whom treat their doctors as enemies, not allies. But everyone should be a partner, not a pugilist, in this vital relationship.

And it’s just plain better for your health. “It’s simply paramount for me to have a congenial partnership relationship with my patients if we’re going to make effective lifestyle and health-care changes,” says Dr. Robert Hauptman, a family practitioner in St. Albert, Alta. Check out the following tips for forging a better bond with your hard-working doctor.

Book the time you need

“Be upfront with the receptionist about why you’re coming in, so she can schedule sufficient time for your appointment,” suggests Dr. Maureen McCall, a family practitioner in Red Deer, Alta. “Every day, we’re faced with somebody who comes in with a gargantuan problem booked into a 10-minute slot.”

Arrive prepared

“As a partner, you have to be ready for the visit, too,” says Dr. Cathy MacLean, a family doctor in Halifax. Prioritize your concerns, know the questions you want to raise and, if necessary, practise asking them beforehand. Have it clear in your mind what your symptoms are: what kind of pains you’re having—short stabbing bursts or long dull aches? When did they start? Make sure to give your most serious issue top billing, as that should receive the most attention from your physician. “The other day, I saw a patient who had a number of concerns, and we dealt with as many as we could,” recalls Hauptman. “As I was walking out the door, the patient said to me, ‘So what about this chest pain I’ve been having, Doc?’ I’m like, ‘OK, you probably should have mentioned that one first.’”

The patient laundry list is legendary among doctors, but go ahead and bring it in, Hauptman adds—as long as the items are listed in order of priority. That way, you can deal with the top couple of issues at this appointment and a book a follow-up for the others. You’ll leave feeling satisfied.

Know thyself

Be well informed about your own health and tell your doctor the things she needs to know. You should keep your own records of allergies and immunizations, advises MacLean. Learn your family medical history, adds McCall, as this may help identify any genetic conditions for which you’re at risk.

Admit what you’re taking

If you’re elderly or taking multiple medications, bring in all the medicine bottles to your appointment, including vitamins and herbal supplements, says Dr. Susan Gleeson, a family physician in Peterborough, Ont. “Patients fear that doctors are not going to be happy with them for taking supplements, but we want to know because some of these can have drug interactions with prescription medications.” Hauptman adds that often a patient will ask a new doctor for a repeat of pills he has at home and knows only as “the red ones.” This can lead to a lengthy process of trying to discover which drug the patient means. Bringing in those bottles saves time and confusion.

Comply or confess

Follow your doctor’s instructions; if you do not, be honest about it. Gleeson once placed a patient on a new antihypertensive medication, only to find three weeks later that his blood pressure was still high. He had not started the meds and had neglected to let her know. “If someone’s withholding information, it can take a long time to figure out what’s wrong,” she explains. “You have to be upfront.”

Use reliable sources

With the Internet bursting with medical advice, some patients feel that becoming board-certified specialists is a matter of a few clicks, no training required. But, says Dr. Alain Pavilanis, a family physician in Montreal, it’s important to respect the expertise of your physician. “Coming in to the doctor and challenging him about everything is not a good way to develop a partnership. But that doesn’t mean you don’t ask questions—you should.”

While some doctors cringe at the sight of a patient armed with sheaves of Web printouts, Pavilanis doesn’t mind—as long as the sources are reputable. “A well-informed patient is a blessing in this partnership,” he says, “but a patient who comes in with information the physician would not validate poses a challenge.” Sources, for example, that question mainstream medicine, such as naturopathy or homeopathy, are not going to be particularly useful in the physician’s consulting room.

Show up for a follow-up

Part of good health care, after all, is monitoring treatment to see if it’s working. “Ultimately, your health is your responsibility,” says  Pavilanis.“A doctor can prescribe a follow-up appointment in three months, but it is still the patient’s responsibility to book the time and come in.”

Get serious about lifestyle

Dr. Stephen Major, a family doctor in St. John’s, Nfld., is gratified when a patient follows his advice to adopt a healthier lifestyle. “It’s easy to write a script and get someone to take it,” he says, “but the greatest long-term success is often found in better diet, more exercise and quitting vices such as smoking.” Major cites the example of a diabetic man who also drank alcohol to excess. With the help of his wife, this patient took Major’s lifestyle recommendations to heart. The man got on the wagon through Alcoholics Anonymous, improved his diet and became more active. “His blood sugar is now in the non-diabetic range, and we can consider withdrawing some of his medications.” For Major, the partnership for good health extends far beyond the walls of his office. “Some people out there expect the doctor to fix them, but the reality is, a lot of the fixing comes from what patients do for themselves.”

The perils of practice

Being a family doctor has its unique challenges. For Hauptman, cellphones are a real intrusion. A sign in his office asks patients to turn off their mobiles—with mixed results. “I can’t help you if you’re on the phone,” he tells them. And while she understands that people’s lives are chaotic, MacLean has trouble with patients who repeatedly miss their appointments, and even knows some for whom the doctor “plays second fiddle to the hairdresser.” She also has trouble with patients who show up for appointments—but with additional people in tow for the doctor to see in that same consultation.

The worst thing for Major is spending a lot of time and a fistful of health-care dollars on getting a patient well, only to see that patient turn around and engage in self-destructive behaviour. He remembers a woman who spent a full month on a ventilator in intensive care for her asthma. A week after coming off the ventilator, he says, “there she was standing by the hospital entrance having a cigarette. I mean, an ICU bed can cost $1,000 a day.”

On an uglier note, doctors are often threatened by agitated and enraged patients. “Once, I was angrily berated by a female patient who said that because I was a man, I was insensitive and unable to understand what it’s like to be a woman and therefore not capable of being her physician,” says Pavilanis. He found her remarks hurtful and offensive in the extreme.

MacLean once had to file a restraining order against the companion of a chronic-care hospital patient who was not responding to care. Although nothing more could be done for the patient, the companion believed his charge was not receiving adequate treatment. “He basically told me that he wanted me in a grave,” she says.

And although they’ve pledged first to do no harm, family doctors sometimes find themselves in harm’s way. McCall once had a drug-addicted maternity patient come in off the street at a hospital in Edmonton. “Just as I got in position to check on the progress of her labour, this woman planted her foot on my chest and kicked me right across the room.”

Major once had a situation in the ER with an aggressive Alzheimer’s patient. “She was cursing and swearing. She took a swing at me, hit the nurse and pushed me away,” he recalls.

But the most dangerous incident was faced by Hauptman when a paranoid schizophrenic man came to his office with intent to kill. Fortunately, the man had started his search for Hauptman at the local hospital, which tipped him off that the dangerous patient was on his way. When he arrived, Hauptman was waiting—with a powerful sedative at the ready.