A 2006 survey of
Mayo Clinics in the US
found that patients identified seven ‘ideal physician behaviours’. They wanted
their doctors to be confident, empathetic, humane, personal, forthright, respectful
and thorough.1 All that – as well as diagnosing their problems!
David*, 43, was
diagnosed as a teenager and has experienced HIV health care all over the world,
where he has been variously made to feel like a “leper” and a “walking weapon”.
It was only in 2000 that he came under the care of a London clinic and finally stabilised his
medication. “Half of the information the doctors can use comes from myself, so
I’ve learnt that it’s important to be honest and open,” he says.
He has other medical
issues not related to his HIV and sees several physicians from different
disciplines and hospitals. “I put them all in touch with each other,” he says.
“My GP, my three consultants – they all need to know what’s going on.”
He is happy with his
team, but he had to take control in order to get access to the right people.
“My first GP was young and she had never dealt with anyone like me before.
There were certain areas where she seemed unwilling to help, even though I had
the backing of a consultant.”
Finally, David asked
to speak to someone else and saw the head of the surgery. “He was experienced
and understanding and is now my GP. I have a very good rapport with him.”
Alison* is a
36-year-old mother of two from Fife. She has
been living with HIV since she was 19, when she contracted the virus from a
former partner. She has a good relationship with her Edinburgh consultant, who she has been with
for ten years. “I see her every six weeks. I think I’m her ray of sunshine,”
Alison jokes. But she hasn’t always experienced ‘ideal physician behaviours’.
“My first baby
wasn’t planned. I’d only been diagnosed for two years and I didn’t know as much
about the condition as I do now. My GP told me it would be better to have a termination.
I was frightened and could easily have taken his advice, but instead I went to
the clinic where they put my mind at rest.”
When Alison’s second
child was born, he emerged from the caesarean “a bit jittery”. “They kept
asking me what recreational drugs I’d taken during my pregnancy. They made
assumptions because of my diagnosis. I was so angry. Now I’m not afraid to
speak my mind or say something is not relevant if I don’t believe it is.”
Alison now bypasses
her GP’s surgery and goes to the Edinburgh
clinic directly. “Speaking to my GP is pointless,” she says. “More often than
not, because of my condition, they end up referring me to the clinic anyway.
And I’m always aware the GP is under time pressure.”
Dr Phillip Hay is
Reader in HIV/GU Medicine at St George’s, University of London, where communication skills form
an important part of the curriculum. So what does he tell students about
talking to patients? “One of the things I do say to my trainees, one of the
arts of medicine, is to give the impression that you have limitless time with
the patient in front of you, even though you don’t. Show that you are giving
them 100% of your attention, not looking at your computer or your notes, while
they are telling you their story.”
Dr Ann Sullivan, consultant
physician in HIV/GU Medicine at Chelsea and Westminster Hospital, puts her stereotypical
doctor’s bad handwriting down to the fact she looks at patients while she is
taking notes. “If I’m sitting there, spending more time looking at the computer
screen, like some GPs now do, then I might miss the fact that you’re rolling
your eyes when I’m saying ‘oh, don’t worry about that headache’.”
Alison says, “My
consultant lets me have the time I need. Whether I’m in there for 10 or 30
minutes, I don’t ever feel rushed. I always leave feeling satisfied.”
Being a good
listener is key but, according to one study, doctors typically give a patient
23 seconds to speak before they interrupt.2 However, this doesn’t
necessarily mean they think you’re time-wasting or saying something of no
importance. “The patient can feel they are short-changed or haven’t had a
chance to speak, but a lot of that is the doctor guiding the conversation to
get to the bottom of a diagnosis because of the limited time,” says Ann Sullivan.
“I’d hate to think that a patient had left an appointment without asking what
they meant to ask. Ideally, at the end of the consultation I’d like to feel
that I’d given them the information they needed and that I’d found out the
information I needed to deal with their issues – whether it be about their HIV or
their general health.”
It’s a two-way
process, a trading of information. So, to turn the Mayo Clinic study on its
head, what are ideal patient behaviours?