Do You Avoid the Doctor? Improving the Patient-Doctor Relationship

Doctor smiles while talking with patient in officeFor many people, the family doctor is the person we turn to with some of our most vulnerable personal information. We go to our doctor to talk about how to keep ourselves healthy and how to manage illnesses. Sometimes we share details that we might not even share with our own partner.

We hope our doctors will offer us care without judgement. Doctors also hope they can serve their patients well and that they can put their training and knowledge to use. This can be a great relationship, in which patients feel heard, understood, and taken care of by their doctors. However, given the vulnerability of the patient and the stressors faced by doctors, this relationship can be damaged, often with great cost to patients.

In my therapy practice, I frequently talk to people who feel misunderstood or mismanaged in their pursuit of medical health services, and they develop a kind of phobia around working with doctors. This can happen with any person, but I have noticed that this concern is commonly presented by diverse people; specifically, people who are racialized, LGBTQ+ people, and differently-abled people.

What Is a Good Relationship with a Doctor?

The ideal doctor-patient relationship has shifted over time. It has moved from a more authoritarian model, in which patients trust and comply with doctors absolutely, to a more patient-centered approach, in which patients are viewed as autonomous, holistic individuals. Currently, doctors often work to understand medical problems through the lens of the unique patient (Kaba & Sooriakumaran, 2007).

The foundation of a strong doctor-patient relationship is trust, knowledge of each other, regard, and loyalty; these factors impact the physical and mental health outcomes of patients (Chipidza, Wallwork, & Stern, 2015). In an ideal doctor-patient relationship:

  • The patient trusts that their doctor is competent and caring.
  • The doctor trusts their patient’s experience.
  • The patient and the doctor have gotten to know each other.
  • The patient feels as though their doctor likes and supports them.
  • The patient is willing to forgive errors their doctor might make.
  • The doctor does not abandon the patient.

Unfortunately, with the reality of time constraints, a high ratio of patients to each physician, costs associated with health care, and the management of urgency that doctors contend with, it can be very difficult to develop the ideal doctor-patient relationship. Many of my clients believe that their doctors are not trying hard enough, don’t understand them, or have the “wrong idea” about them. Many of my clients who are doctors feel that the systemic issues in health care impact their ability to provide care to the standard they wish to.

What Is the Impact of a Poor Doctor-Patient Relationship?

When patients feel unheard, disrespected, or have different plans for their health than their doctor, there can be negative impacts on medical and mental health (Gordon & Beresin, 2017), including reduction in adherence to treatment, changes in emotional state and symptoms, a change in frequency of visits, and a change in coping tools. Given that the goal of medical work with a doctor is to improve health, it is clearly imperative that the patient and their doctor have the best possible relationship.

From my observation, the costs of a poor doctor-patient relationship extend beyond physical health outcomes. Clients report a profound distrust for authority figures, shame, self-criticism about their perceived failure to “get better,” and avoidance of health professionals that lasts far beyond the specific encounter with one doctor.

Although the root of these problems is often multifaceted, patients who perceived they were treated wrongfully, were disliked or disrespected by their doctors, or whose trust and confidentiality was violated carry a trauma from these situations that impacts their overall health and psychological well-being

For some patients, this means mental health problems go untreated for long periods of time, impacted by the fear that a doctor will judge mental health symptoms harshly. Some patients even experience a phobia of doctors, called iatrophobia. Although the root of these problems is often multifaceted, patients who perceived they were treated wrongfully, were disliked or disrespected by their doctors, or whose trust and confidentiality was violated carry a trauma from these situations that impacts their overall health and psychological well-being.

How to Process Negative Experiences with Doctors

The first step to understanding how your relationship with your doctor impacts you is to examine how you feel about visiting your doctor. Consider what you liked or disliked about the experience and identify whether you have the basis of trust, regard, loyalty, and knowledge within your relationship with your doctor.

You may want to talk your feelings through with a trusted friend, family member, or therapist who understands your situation. If you feel you can trust your doctor and that you may be able to express your feelings about your care to your doctor directly, doing so can be a great first step in repairing damage that was likely unintentional.

Recognize that for many patients, especially those who are LGBTQ+ or who come from different cultural backgrounds than their physician, a lack of awareness on the part of the physician can damage the patient-doctor relationship. Acknowledging that the problem might not be about you and instead about a lack of awareness or knowledge on the part of the physician can help you depersonalize the situation and consider other options.

What Do You Need from Your Doctor?

Consider gathering information about your specific problem, how it is typically managed, and what you want to see happen with your health prior to visiting you doctor. It may be that what is bothering you is related to discomfort with treatment options, and there may be alternatives. It may also be that you feel you have a greater problem with your doctor that can be explored through their registration body. You may be able to find other physicians you feel more comfortable with or who you believe understand you and your situation more thoroughly.

If you experience a phobia of doctors and medical procedures, it may be helpful to seek a therapist who can work with you about this. The most common approach for dealing with phobias is exposure therapy, which is designed to help you gain comfort and establish tools for managing fear and anxiety that arise when you go to appointments or have to participate in medical procedures (Milosevic, & McCabe, 2015). You may also engage in cognitive behavioral therapy (CBT), hypnotherapy, or group counseling.

Ensuring that you seek timely and sufficient medical care can make a big difference in your overall health, and it is worth working on this issue.

References:

  1. Chipidza, F. E., Wallwork, R. S., & Stern, T. A. (2015). Impact of the doctor-patient relationship. The Primary Care Companion for CNS Disorders, 17(5). doi:10.4088/PCC.15f01840.
  2. Gordon C. & Beresin, E. V. (2016). The doctor-patient relationship. In Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia, PA: Elsevier Health Sciences.
  3. Kaba, R., & Sooriakumaran, P. (2007). The evolution of the doctor-patient relationship. International Journal of Surgery, 1(5), 57-65. doi: 10.1016/j.ijsu.2006.01.005
  4. Milosevic, I. & McCabe, R. E. (Eds.).(2015). Phobias: The psychology of irrational fear. Santa Barbara, CA: Greenwood.
  5. Ridd, M., Shaw, A., Lewis, G., & Salisbury, C. (2009). The patient-doctor relationship: A synthesis of the qualitative literature on patients’ perspectives. The British Journal of General Practice, 59(561), 116-133. doi: 10.3399/bjgp09X420248

© Copyright 2018 GoodTherapy.org. All rights reserved. Permission to publish granted by Laura Turnbull, MC, CPsych, therapist in York, Ontario

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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