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Improving Doctor-Patient Relationships

Posted: September 28, 2007

Do you put off going to the doctor because you dread the way he or she might respond to you? Perhaps you get the impression your doctor dreads your visits as much as you do!

While in search for pain relief and treatment, patients often experience skepticism, credibility issues, rejection, or unfavorable encounters with doctors.1 Patients say they feel stigmatized and report spending their strength struggling and quarreling with their doctors during consultations or visits.

On the other end, doctors are trained to manage clearly defined diseases so the uncertainty of diagnosing and treating fibromyalgia patients can challenge their professional identity. Often facing multiple symptoms associated with fibromyalgia, doctors are frustrated and tend to view patients as time-consuming, demanding, or emotionally draining.

Recognizing this disparity between patient needs and physician responses, researchers in Germany held a clinical trial that shows how doctor-patient relationships can improve with a little education and active participation (from both parties) when it comes to making medical decisions.2

For the study, researchers recruited doctors to undergo a shared decision-making (SDM) training course as their approach to treating fibromyalgia patients. The SDM splits the difference between a doctor making all the decisions or the doctor providing choices and allowing patients to select their treatment. After 12 hours of training in SDM, doctors in practice contribute their medical expertise on the causes of the disease, symptoms, treatment options, and outlooks. The patients participate by talking to the doctor about expectations, preferences, fears, experiences, values, and social circumstances. After negotiating possibilities, both the doctor and the patient create a plan of action together.

Sixty-seven fibromyalgia patients were recruited for the one-year study. All the patients participated in a computer-based, audio-visual information tool created by the research team that gave instruction on symptoms, diagnosis, treatment options, and prognosis. The tool was created to be used in doctors' offices. The patients were then divided into two groups.

The first group was treated by physicians who had undergone the shared decision-making (SDM) training. The fibromyalgia patients in the second group, who also received the medical information, were treated by doctors not trained in SDM. Consultations were scheduled to provide each patient with an equal amount of time. A third, or control group of 44 fibromyalgia patients who received no special education were seen by physicians in a typical office visit.

Patients met with their physicians and completed questionnaires after an initial consultation, a three-month follow-up, and a one year follow-up.

Through the three visits during the year, the patients in the SDM group consistently reported the highest level of satisfaction, with the information group significantly second, and the control group even lower on the satisfaction scale.

The SDM doctors reported overall that their interactions with their fibromyalgia patients were less difficult compared to the other two doctor groups. While patients in the information and SDM groups both reported higher satisfaction with their doctors, only the SDM group patients could actually communicate why their interaction was better, stating they felt understood, listened to, and believed.

SDM doctors reported less negative feelings about their patients, more pleasant visits, and were able to describe their patients' attitudes and conditions better. On the other hand, the medical information and control group doctors described patient visits as straining, and rarely as pleasant.

Even after one year of visits, patients in the SDM group reported more satisfaction with their doctor-patient relationship, said they were coping better, taking better care of themselves, and experiencing less frustration and disappointment when they actively participated in their treatment plan. Doctors also noted less friction and improved relationships with patients because they were able to explore their patients' attitudes and beliefs, understand and redirect unrealistic expectations, and reduce patients' stress.

The authors of the study comment that "physicians often feel they have nothing to offer fibromyalgia patients if they cannot offer them persistent pain reduction. With this in mind, the high patient satisfaction in the SDM group as a main result of our study becomes even more important. It seems indeed astonishing that patients are satisfied with their doctors despite an only marginal improvement in symptoms."

How are your doctor-patient relationships? A survey done in the United States by Steven Feldman, M.D., Ph.D., of Wake Forest University, on patient satisfaction stated that patients may value technical expertise but are looking for more.3 "Perhaps it is not all that startling that patients value healthcare providers who take time to listen and work with them, care about them, support them in managing their healthcare, and make an effort to personalize patient care."

1. Werner A, Malterud K, Soc Sci Med 57:1409-19, 2002.
2. Bieber C, Müller KG, et. al. Patient Educ Couns 63:357-366, 2006.
3. Feldman S, et. al. J Med Pract Manage 22(5):255-61, 2007.

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