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The Patient As Consumer

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Optimal health care can be achieved
only when patients are educated
about their health and patients and
physicians work together as
treatment partners in an
atmosphere of mutual respect.



Things change...
Things change over time. That's pretty much a given concept. Attitudes change over time, some more quickly than others. When I was growing up, doctors were... well, revered is probably a pretty good word. Everyone respected doctors. It was pretty much unheard of for anyone to question them. When the doctor told you to "take your medicine," you did it, without ever even thinking about why. We would never have dreamed that a doctor might have been mistaken about anything, ever.

It's not cliché to say that things were simpler then; it's just a fact. There were far fewer medications, fewer specialists. What we're finding now is that it's also true that many illnesses and diseases went undiagnosed and untreated. Migraine disease and many headache disorders are among those.

With advancements in medical science and technology has come a proliferation of tests, medications, and specialties. Our family doctors have more and more to learn, yet medical school and internships only last so long. The same is true of specialists, and we're now seeing the development of more subspecialties, which makes a great deal of sense.

Patients have changed...
What else has changed? The patient has changed in many cases. We're bombarded with health stories in the media -- television, radio, magazines, newspapers, the Internet. When it's not news stores, it's advertisements. Much of this is positive; we're shown how we can make changes in how we live that will have a positive impact on our health. We're learning that the answers aren't always our doctors' responsibility. Patients today have more information available to us than ever before, at least in part because of the Internet. We're able to learn about illnesses and diseases, medications, and much more.

As we strive to manage our health, it behooves us to match ourselves with doctors whose personalities and the way they work with their patients fit our needs.

Patients are consumers, customers...
So, who has the patient become? The patient has become a consumer, a customer of health care services. The Merriam-Webster Collegiate Dictionary defines a consumer as, "one that utilizes economic goods," and a customer as, "one that purchases a commodity or service." The Merriam-Webster Medical Dictionary defines a patient as, "a client for medical service." This makes a great deal of sense, especially given the rising cost and percentage of income associated with health care.

This new role of the patient and some of the issues with doctors that people bring to me lead me to ask a question. When you go shopping, would you continue to shop in a store where you're dissatisfied with the product or the attitude of the sales associates? I think not. Why? Because we don't spend our hard earned dollars on unsatisfactory products or bad customer service. Thus, when we consider that a patient is a consumer, a customer of health care services, I would propose that if we aren't receiving the medical care we feel we need, it's time to purchase those health care services elsewhere.

Patients as employers...
In a way, as consumers of health care, we are also employers. We employ our doctors and other health care professionals to help us manage our health in the best ways possible. If you're an employer, you'll be following this thought easily. If not, let's take the example of hiring a housekeeper. We may look in the phone book and hire a housekeeper in that fashion. We're entrusting a housekeeper with the precious possessions in our homes, so we probably check references. The housekeeper is accountable to us, not the other way around. If he or she isn't doing the job we expect them to do, we fire them. Why should it be any different with health care providers? It's not our precious possessions we're placing their hands, but our lives, literally. It's not just our prerogative, but our responsibility to hire the doctor we feel most qualified to handle our care and fire him or her if our expectations aren't met. Obviously, that's not to say that we have any right to be demanding, unreasonable or disrespectful. The point is this:

"Optimal health care can be achieved only when patients are educated about their health and patients and physicians work together as treatment partners in an atmosphere of mutual respect."1

Why we don't change doctors...
Some of us are reluctant to change doctors. We feel that it indicates failure, either on our part of the doctor's. We don't like confrontation, don't want to hurt the doctor's feelings, or just don't feel up to any conflict when we're already not feeling well. When a doctor/patient relationship doesn't work, it's not necessarily a sign of anyone's failure. Regardless of it being a professional relationship, personalities are involved. Purely and simply, no matter how wonderful a doctor is, he or she is not the right doctor for every patient. Don't think of doctors as higher beings. They're not; they're only human. Certainly, if a doctor just doesn't have the experience and training to handle a particular case, they're not the right doctor for that patient. But there are other circumstances under which excellent doctors may not be the right doctor for us. Here are some examples:

  • When the doctor's practice is very large, and there isn't much time to spend with individual patients to answer questions, etc.
  • When the doctor is in a clinic setting, and we don't always get to see the same doctor.
  • When the doctors personality is "all business," and the patient needs the comfort of a better "bedside manner."
  • When the doctor has "run out of ideas." It happens. In any problem-solving situation, a "fresh set of eyes" can sometimes bring a new perspective that changes the dynamics.

"Hiring" and "firing" doctors...
I've honestly known people who put more effort into hiring an excellent hair stylist than choosing their doctor. (Imagine me shaking my head here. That's the least of my reactions.) That, however, seems to be changing. More and more, we're asking questions about doctors before we make that first appointment. We're also asking our doctors more questions than before. Many doctors appreciate the educated patient. Studies have shown that educated patients are more compliant with their treatment regimens.2 Dr. William Young of the Jefferson Headache Center told me, "An educated patient is a better patient. I'd rather have a treatment partner than a dishrag." We need to do a bit of homework before making an appointment with a new doctor. Talk to friends, nurses you may know, your pharmacist. You can also call the doctor's office and ask about their office hours. If you have a certain day off work every week, it's good to find out in advance if the doctor has office hours that day. Once at that first appointment, there are questions we can ask to help us know if the doctor and the rules and routines of his or her practice match up with our needs. Here are some questions to ask a new doctor:

  • If it's a group practice or clinic: "Will you be the doctor I see at every appointment?"
  • "I know I need to take responsibility for taking care of myself. Will you work with me as a treatment partner, with the two of us as a team?
  • How do you feel about patients who ask questions?
  • What do you have your patients do if they need help after hours or on weekends?
  • When you're on vacation, does someone cover your practice?

If you have to "fire" a doctor, don't let it become personal. You don't have to say anything at all to the doctor. You can just go to a new doctor and ask them to get your medical records transferred. If you do want to say something to the doctor, it can be something as simple as, "This just isn't working out well. Thank you for your time." If you leave a doctor, and you want a copy of your records, you should know that a federal law requires that a copy be provided to you within 30 days of your written request. Most offices have a release form they will want you to fill out and sign. They may charge you a "reasonable" fee for the copies. If you are told that they cannot be released to you, ask whomever tells you that to please refer to HIPAA (The Health Information Portability and Accountability Act).

Ultimately, we are
each responsible for our own health. We can't just go to the doctor and expect him or her to make it all better. It simply doesn't work that way. In a good doctor/patient relationship, the doctor doesn't make decisions for us, the doctor makes decisions with us. For this to work, that relationship has to be a sound one of mutual respect. We don't pay out our hard earned dollars for substandard products or services, and health care services should not be an exception. Even with insurance coverage, we do indeed pay for the services because, in one way or another, we've paid for that insurance. Find a doctor whom you can respect and who will respect you. We deserve nothing less.


1 Robert, Teri. "Living Well With Migraine Disease and Headaches: What Your Doctor Doesn't Tell You... That You Need To Know." page 95. New York. HarperCollins. 2005.

2 Rothrock, John Farr, Parada, Victoria A., Sims, Cheryl, Key, Kristin, Walters, Naomi S. & Zweifler, Richard M. (2006) "The Impact of Intensive Patient Education on Clinical Outcome in a Clinic-Based Migraine Population." Headache: The Journal of Head and Face Pain 46 (5), 726-731. doi: 10.1111/j.1526-4610.2006.00428.x

Merriam-Webster Collegiate Dictionary, Online Edition.

Merriam-Webster Medical Dictionary, Online Edition.


Medical review by John Claude Krusz, PhD, MD


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