Doctor’s Orders

“Is it just me, or was that doctor [a jerk]*?”

It wasn’t just her. He was judgemental, condescending, and refused to listen to us. My housemates and I may not have been doctors, but we were not ignorant. I was three-quarters of the way through a genetics degree and four months later, the two of them were accepted into med school. We knew a little bit about the human body.  Still, the doctor clearly saw us as three foolish clubbers.

As an accident prone child, I have dealt with a lot of hospital doctors over the years. Most of the time they are efficient, concerned and proffessional. Still, communication between health care proffessionals and lay people can be improved.

According to Lee and Garvin (2003) the general assumption of health care providers is that people act unhealthly because they don’t know any better. Therefore, if you just give people more information they will improve their health. Tell people they need to get pap tested regularly to avoid dying of cervical cancer and they will go get pap tests.  Except this ideology doesn’t take into account social factors such as being too poor to pay for medical tests, transportation or medication should something actually be wrong.

Sometimes a person’s physical well-being looses out to thier social well-being. I know I’ve done some ill-advised things to fit in. What if you know drinking and smoking are bad, but you come from a culture where you cannot refuse a senior collegue who is offering you a smoke and a drink?  I know sun tanning causes cancer, but my society insists people are much more attractive with a tan. What to do? Well I suppose I could move to China where pale skin is sexy, but that seems a bit extreame. In these situations usually people will just ignore the health advice.

Besides blaming the individual for their poor life choices, health care providers also tend to assume that they understand the situation best, based on the fact they are the experts and lay people are not. I may not know all the symptoms of cerbral palsy but I know my body. This ‘I am a doctor and therefore I know better than you’ leads to a monologue where the doctors/experts just tell their patients (lay public) what they should know.

Instead of this one way information transfer Lee and Garvin suggest health care should move to a two way information exchange. In the future if you tell a doctor that you have tried a medication before without any results then the doctor should listen to you instead of prescribing it anyway.

Still, I think about about all the pseudoscience cures the public can access online and wonder what new challenges an information exchange between the public and health care systems will bring. Do you think it’s important for doctor and patients to discuss both homeopathy and chemotherapy when choosing how to treat cancer? Will an exchange be more or less beneficial? Please leave your comments below so that we too can engage in an information exchange.

*as this is a university assignment I felt it necessary to sensor the actual quote.

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DeTurk, M. (2009). Adam’s a doctor [photo]. Retrieved from http://www.flickr.com/photos/dalboz17/4274454323/

Lee, R. & Garvin T. (2003). Moving from information transfer to information exchanged in health and health care. Social science & Medicine, 56, 449-464.

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7 comments so far

  1. axl1228 on

    It reminds me the last time I had acute bronchitis. It was spring; the weather in Shanghai was very changeable, and I coughed a lot. I went to hospital and took a chest X-ray. On the report it said that I got acute bronchitis. Then, I took my X-ray report to the doctor. He just took a glance, and said:”Ah! Tracheitis!” Tracheitis and bronchitis only differ in one character in Chinese, but at least they are different. Although I’m not a science person like you, I guess they are kind of similar, but the doctor didn’t explain that to me. He wrote fast on the prescription, and I assume that doctors’ handwritings all over the world are the same. When he finished, he headed up and looked at me, left me a word that I can never forget – “It will be fine when the weather gets warmer.”
    But is that all the doctor should be blamed for? I guess not. I failed to ask him the difference between the terminologies, and I didn’t ask him the reason about weather either. We are kind of used to the monologue when seeing a doctor.
    In China, when you see a doctor, you would probably have to wait in line for one or two hours, and only able to talk to the doctor for 5 minutes. That’s might be another reason moderating the dialogue between doctors and patients. We regard the working efficiency far more important than communication effectiveness.
    Anyway, Good work. I really like your opinions and stories. Nice post!

    And welcome to China. You can rid of the social preference of being tanned, but just look out for the air pollution. Skin cancer? or Bronchitis? What a cruel world.

    • shortfletch on

      Your comment made me laugh, thank you.

      You said that China values working efficiently over working effectively, but if you get diagnosis right the first time, doesn’t that make the process more efficient in the long run?

      I do think it can be very intimidating to stand up to doctors. My neurologist asked me if I was organized and I said “no not really” so he suggested I use an agenda and make to do lists (I already did both those things, so I was a lot more organized then he though) but I was too afraid to tell him this, so I just nodded my head. It’s hard to ask a question, when the doctor has already become uninterested in you and is shuffling his papers around, getting read to walk out the door. You feel like your interrupting their busy schedule (which is silly because it is their job to help you).

  2. noelynn on

    First of all, I acknowledged the good structure of the post. Good job!

    I think it’s important for the doctor and patient to discuss treatments and other related issues as far as the patient is concerned. The doctor cannot just give an order, though the patient is totally obliged to trust him. I think it’s also healthier for the patient to understand every word uttered by the doctor upon consultation. It is equally important for the doctor to communicate clearly to the patient.

    I can also identify well with axl1228, you trusted the doctor so well that you cannot even pose a question. I guess apart from the long waiting period, you just want to leave the premises after presenting yourself to the doctor. However, as a patient I think you have the right to know what’s going on in your system (body).

    Finally, in my opinion a dialogue is better than a monologue in the case of doctor – patient.

    • shortfletch on

      I agree with you.

      I think it is really important that a doctor explains why they are prescribing or telling you to do certain things. For example, doctors will tell people to take antibiotics for a certain number of days; however, many people stop taking the medicine when they start feeling better. This is really dangerous because it leads to the creation of super resistant bacteria. Patients need to take all the medication for the prescribed length of time. However, how would anyone know this if they were not told?

  3. rhiandyer on

    I can see that sometimes communication is more efficient as a dialogue but I think we have to be very careful when applying it to the medical industry.

    I think the most worrying aspect of announcing the patient-doctor relationship a dialogue is the logical conclusion of direct-to-consumer marketing of pharmaceuticals. The first world have done a good job of ensuring that doesn’t happen anymore (except the USA, but that is probably the least of their concerns) but now it will be a lot easier to catch people on the internet.

    Imagine people walking in and telling the doctor what medication they want and not the other way round.

    • shortfletch on

      I did imagine patients walking in demanding drugs. That is a slippery slope, especially for drug addicts. Give me morphine, I need it now.

      It must be a little bit like that in the US. They advertise drugs on television and then say “talk to your doctor to see if … is right for you”. I wonder how many doctors have to talk patients out of drugs?

  4. keikok on

    It is an interesting topic and you had good use of the stories from your peers. I liked the way you compare the cultures between countries. Since I also share the house with my friends who are from different countries and we all have different culture, we often find cultural differences. I think it is such great opportunities to share the time with these friends because I can see and learn about the other countries throw them. This is happening because we communicate each other. We wouldn’t be able to know each other without any communications. Without it, we might misunderstand each other and start thinking that the others hate you. It is same as the relationship between doctors and patients. They will not be able to understand each other without communications. It is the job for doctors to think about their patients and explain their disease to them in understandable way but on the other hand, I think it is the job for patients to ask questions if they do not understand.


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