Maintaining Your Health on Mackinac
Practical Issues That Can Guide Doctor-Patient Relationships
By Yvan Silva, M.D.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.

The Hippocratic Oath, or current day modifications of it, remains ingrained in the graduation and practice of all physicians. There are no corresponding guidelines for patients as to their participation in the partnership that doctors and their patients enter.

Clear and continuing twoway physician-patient communications are, inarguably, most important in all the simple, as well as complex, decisions that are made in health care. Practically speaking, this should be a partnership in which the patient should communicate openly and honestly about all concerns relating to health care needs or concerns. The physician, on the other hand, must convey important information in a clear, understandable way, while encouraging full discussion of issues important to the physical and emotional needs of the patient. Full consideration for the family members and other important social elements should be included. The challenges increase with the nature of the problems, their evolution, and are most evident at times of emergencies and other times of serious decision making.

There have been considerable and rapid changes during the evolution of health care delivery over the past few years. The time allocated to or available for many interactions appears to be critically short in the view of many patients; there is more difficulty than ever before because of tremendous advances in science and technology. The medical and legal literature continues to elaborate on the importance and demands for informed consent, full disclosure, and standard of care for treatments and management of patients. The rights of patients, and more recently the stringent legislation relating to privacy, are established in the spectrum of health care delivery. Beyond the old-fashioned doctor patient relationship, we now live with multi-disciplinary specialization - one patient with many doctors and many ancillary caregivers, and the problem of getting answers to questions and concerns in a timely manner. There are several initiatives that are being introduced across the nation in health care facilities to improve communications between physicians and their patients so that patients and their families or representatives can be fully informed and actively participate in the decisions about preventive methods and treatment of disease.

What should you expect from your doctor? Information about your condition, the tests and procedures that will be required to clarify the diagnosis, and the options that are available to you to deal with your problems. There should be sufficient time to address all issues thoroughly, good accessibility to the physician, and time available for follow up discussions and plans for treatment. Specific instructions are very important for treatment of your condition, and detailed information on medications is essential, especially with possibilities of drug interactions and adverse effects. Physicians are required by state laws to attend continuing medical education programs so that the practice provides patients with the latest advances in medicine and answers for questions about recent, emerging treatment methods. Physicians should encourage patients, and importantly, their families and loved ones, to participate in understanding the issues and help, when appropriate, with health care decisions.

Patients who prepare for an office visit can make the most of the time they have together with the physician. You should put questions of importance to you in writing, and go over them during the visit. Give the list of questions to the doctor for your file, if they're deemed important to you now, and for follow up in future. Write down your symptoms or health concerns that you have. Be specific, when possible, and include what the symptoms are, when they started, their severity, and resulting changes to your daily life and activities. What triggers the symptoms and what relieves them are helpful things to know, as well as lifestyle changes you have made. Lifestyle habits should be honestly and fully explained, such as your smoking history, use of alcohol and other drugs, sexual history, and treatments you're already receiving. Provide the physician with an accurate list of medications you're taking (prescription and non-prescription), vitamins, supplements, or alternative treatments you are using. Be sure to bring up any religious or cultural beliefs that might affect treatment options. Make sure you understand the recommendations made, and the reasons for them. Written instructions are always best - they form a solid basis for discussion with other doctors, family members, and others involved in your life.

Dealing with specialists who are called upon to treat you need not be difficult. Referral to a specialist is usually specific, to provide you with the expertise you require for treating your condition. You should ensure that all information pertaining to your care is available to the specialist, and that there is good communication on both sides, before you submit to the recommendations. If you are uncomfortable, or if you want to for personal reasons, you may obtain another opinion from another specialist. Elective surgery is perhaps the most common issue in this regard.

All of your discussions with health care professionals are privileged and confidential. Your doctor will not share this information with anyone without your express permission. A waiver, signed by you, is needed to do this and to maintain the integrity of your rights of privacy. Thus, you should not be afraid to be completely open and honest about sensitive issues. These may be more important to discuss than you think. You should feel that such disclosures are met with understanding and can result in practical solutions. If you cannot talk to your doctor, if the relationship is not satisfactory, or you're not getting appropriate help with your problems, and if there does not seem to be room for improvement, you may want to consider changing doctors. This can be a wise decision that should be made free from a sense of loyalty or personal discomfort.