Is it Ever Appropriate to 'Pry' Your Patients?

The doctor patient relationship is the foundation on which medicine is built. The foundation of this doctor-patient relationship is communication. A doctor who masters the art of communication is one of the best. It’s very common to find doctors who can ace any test and recall every single sentence from a medical textbook, but who fail at talking to patients and therefore aren’t that great clinically. On the other hand there are doctors who may not have textbooks memorized word for word, but they make up for this through their effective methods of communication and talking to patients. If you can talk to a patient,  then you earn their trust and can therefore find out more about them. This will without a doubt aid you in diagnosis and getting them to comply with your instructions.

Sometimes patients can be guarded and you have to maneuver the conversation in order to get them to tell you certain information that you think can be important clinically. It’s necessary to not pry too much. If a patient doesn’t want to talk to you about something, then maybe leaving it alone is the best thing to do. When it comes to making medical decisions regarding treatment, don’t take the patient’s shyness as an excuse to make their decisions for them. At the end of the day, it’s their decision, not yours, and you need to discuss everything with them clearly and plainly.

Doctors asking too much and insisting on knowing can be misunderstood by patients as prying. In reality, doctors want to know because this could help them detect risk factors, which in turn will help with disease prevention. Also, collecting all relevant data can help with diagnosis as well as treatment. A patient may avoid a question regarding drug abuse, for instance, and consider it a private matter, but it’s important for doctors to know whether or not a patient uses drugs because opioids (for example) can alter how certain prescription drugs work on the body. Sexual history is another topic that might be a bit sensitive, but STDs and sexual history are important in certain cases, especially when it comes to obstetrics and gynecology. Physicians trying to find these things out should approach the topic in a calm manner and reassure patients that everything they say is absolutely confidential. Maybe a patient is afraid of admitting drug abuse because they’re worried the doctor will call the cops, or they're embarrassed to talk about their sex life because it’s a private and sensitive topic. A good doctor will learn how to extract necessary information without distressing the patient.

Finding out information about patients illegally is a crime punishable by law. You should never look at patients' files that you don’t have access to. A group of doctors in the UK were punished for doing this and rightly so. Patient confidentiality is a very serious issue, regardless of where you’re practicing medicine. Patients losing faith in this confidentiality can lead to the collapse of their relationships with their doctors.

Regardless of what they choose to tell you or hide from you, you have to be completely honest with patients and explain everything clearly. If you’re giving them a drug, then you need to explain the side effects to them. If a male is diagnosed with breast cancer, they might require oral contraceptive pills. These pills can result in gynecomastia, which is the enlargement of the breasts. Many males might be opposed to this treatment, but would you rather they figure it out on their own or expect it because you told them? Imagine a man waking up one morning with enlarged breasts. He’s going to accuse you of doing this to him, simply because you didn’t warn him that it might happen. The same goes for women who require androgenic drugs which will result in increased body hair and a deeper voice. These can be very distressing and if you feel that the use of these drugs is absolutely necessary, then you must warn them first.

If you tell them what’ll happen then they’ll know it’s natural for these side effects to occur and won’t be alarmed. If they’re alarmed, then they might stop using the drug and never visit you again. Another popular example is when someone is on Rifampin, an antibiotic which might cause the red discoloration of urine. This discoloration is in no way harmful, but it would be completely understandable if a patient freaks out and thinks they’re peeing blood. They’re going to stop the drug and rush to the hospital or possibly another doctor. Not knowing what might happen next and what to expect can affect patient compliance negatively. You need patients to follow your orders in order for them to get better. Before procedures, you need to explain to them the complications of the procedure and that there’s a chance this procedure may not work. Don’t surprise patients with the results of the things you do. Explain how this will be good for them and how it might harm them.

Now that you’ve diagnosed and explained the situation to your patient, you should never make their choice for them. If you’re in a situation where a patient can choose between taking a drug or having surgery, then explain both alternatives to them and let them choose. If they ask you what you think is best, then you may give your opinion, but you should never make the decision yourself. For example, there’s a condition called fibroadenoma of the breast, which is a benign tumor that may affect females. The pericanalicular type of fibroadenoma will never turn malignant and will have absolutely no effect on a woman apart from a small breast lump. There is really no reason to remove it. You present the patient with the facts. You tell her that it can be left alone and won’t result in any complications, but it can be removed if she prefers. The decision is up to her. If she wants, to remove it you can’t spend time convincing her that it’s unnecessary and that it’s completely benign. You already gave her the facts.

Of course, you can’t force treatment unto anyone either. Patients who don’t want to be treated should be left alone. A patient with cancer who doesn’t want to undergo chemotherapy shouldn’t be forced into it. Tell them the alternatives and the consequences of their choice and that’s it. It’s not a doctor’s duty to save a person’s life by force or give them a treatment they don’t want. Of course, if your patient is depressed or has another psychiatric condition that has an effect on their decision making, then you should refer them to a psychiatrist. If a patient is unconscious or incapable of making their own decisions, then their next of kin should be the ones to decide, or if the patient has a written will, then you should follow it.

Communicating with patients can be tricky and takes training. Becoming a good doctor isn’t just about knowing your medicine, but also knowing people. If you don’t know how to deal with patients, earn their trust, and win them over, then all your medical knowledge and skills aren’t being put to good use. When talking to patients, take care to not cross any boundaries or else you risk the patient withdrawing from you and not being able to trust you. When it comes to making decisions, you need to start by making things as clear as possible. Tell them everything about their options even if they don’t ask. Remember that they didn’t go to medical school and may not know what to ask about and what’s important. Finally, it’s their life and their decision to make not yours. Don’t force anything on the patient and let them decide.