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If Only Your Doctor Knew.

© Dr. David L. Phillips

The essence of most human endeavors is good communication. The successful outcome of most health care pursuits depends on accurate and thorough communication as well. A patient's expectations and those of their doctor are often widely at odds. Many times this is due to a lack of communication, as well as unrealistic expectations on both sides. We doctors expect our patients to be completely compliant, fully co-operative, able to think and act as mature and well-adjusted adults (even the youth and children that come to see us), and to dedicate themselves to getting better. All the while we also expect that you will continue paying our fee, keeping your appointments and respecting our time.

Patients think that their doctors should all be as they appear on TV - wise, understanding, incredibly perceptive, diagnostic wizards, and only seeing one person in a day...them.

Doctors often think that their form of treatment is the answer; the be-all-and-end-all for every patient that they see. We in the healing professions should be aware that this is simply not realistic. Sometimes we need a collective reality check. This seems exactly what the designers of a recent study from Boston thought when they set out to discover just how far apart the expectations were between what the patient felt of the treatment and what the health provider thought when all was said and done.

The study examined 35 patients who had undergone surgical fusion for lower back degenerative disc disease. They compared the outcomes of these 35 patients by asking each what they thought the results had been, and then asked the surgeons what they thought. This is the health equivalent of that television game show, "The Newly-Wed Game".

Just like that TV show these results were often widely variable. Both the physicians and the patients used the same 2 health and function questionnaires. The doctors felt that 16 of the patients had shown "major improvements", 16 showed "minor improvements", and only 3 had "no change".

Meanwhile, only 4 patients felt "much better", 10 were "somewhat better", 12 felt "about the same", 7 were somewhat worse" and 2 rated their results as "much worse".

This kind of analysis is just what people working in the health field need on occasion. To ascertain how a patient is progressing I try to ask questions that are as objective and as quantitative as possible. Such word images as rating their progress or their current pain levels on a scale of 1 to 10 really help me to gain an insight into that person's health expectations. I feel that I need a realistic view of the patient's appreciation of my therapy as we progress along from appointment to appointment. One of the most significant things missing in the health-delivery area is objectivity, and I feel that all therapists need to be self-critical more often.

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