Building Empowerment in the Patient-Doctor Relationship

There are many ways to build an empowering relationship with your doctor and, while the doctor sees many diverse patients, he uses the same strategies to build the relationship with you but on a personal level. According to a landmark paper, Peabody (1927) stated that without this relationship it is impossible to adequately care for the patient In 2024, Fuehrer et al, sought to identify how physicians build connections with patients, especially in the areas of communication and behaviours What emerged from the study were 5 themes for establishing a relationship-centred approach with patients: focused listening, respect for the patient, engaged curiosity, mutual participation, and self-awareness

Focused listening: The first impression in any relationship is especially important and it involves active listening or listening with concentration to the patient’s story A doctor who types on his computer while you are telling your story does not create a good first impression or a trusting relationship The doctor is disengaged in the patient-doctor relationship when this happens It was found that doctors need to turn away from their computer and directly engage the patient, making eye contact and listening with concentration to what the patient is saying

Respect for the patient: The doctor needs to hold their client in high regard and look at the whole person, not just the symptom (like abdominal pain) The patient is not the abdominal pain in Room 4 Bed C but is a

Engaged curiosity for the patient’s story: Curiosity was found to be important in fostering a connection while sharing understanding and compassion for the patient. One doctor described a desire to understand what expectations the patient had for the visit Another doctor sought to understand what was important to the patient This curiosity enabled providers to elicit information that helped to understand where the patient was coming from and then to provide care in a meaningful, genuine way that the patient was able to participate in

Mutual participation: This domain is so importantimproved bonding in the relationship builds on an equal balance of power between the doctor and patient Both parties are experts: the patient is an expert in their own health experience and the doctor is an expert in medicine The patient should always make their own decision as long as they are properly informed by their doctor. Doctors should be empowering the patient to be involved in managing their own care. Teaching and mentoring the patient is important so they can build that equal balance of power with the doctor and be independent of the doctor at times.

Self-Awareness: One of the most important ways to improve authentic relationships with patients is for health care providers to improve understanding, be sensitive, and experience the feelings of a patient (empathy and compassion) When it comes to the patient-doctor relationship, there is no standard approach to authentic interactions Real connection relies on both parties to honestly express their thoughts and feelings (Fuehrer, 2024) With an appreciation for ones own values, beliefs, emotions and boundaries sometimes it is best to be transparent and say, “I don’t feel we have a connection” or, “This isn’t working for me- how can we do this better?”

Many patients do not understand how to communicate effectively with their health care providers. It makes sense that a layperson cannot grasp the anatomical and physiological principles that took their doctor years to learn. Also, doctors often forget that patients do not always understand medical words and terms. This disparity is the cause for missed or delayed diagnoses, excessive testing and inadequate treatment (Hester, 2022).

Working with your doctor to improve the relationship:

The ongoing relationship between any patient and provider is based on two-way communication with mutual participation being the key to the whole relationship. The Alberta Health Charter (2014) sets out the roles and responsibilities of both patients and providers within the health care system. If the relationship is one way, the result is excessive testing, missed diagnosis, extra follow up visits, too much time off work, poor outcomes, ineffective medication or too much-too little, and prolonged suffering (Hester, 2022).

Have your story ready before the doctor walks into the room (Haupt, 2023; Hester 2022). Write it down at home along with your biggest worry/concern and read it to the doctor There are eight things the doctor is looking for in your present illness: location (where is it); duration (how long does it last); quality (what is it like); things that change it -make it worse or make it better; other signs/symptoms; timing (when is it happening-all the time, short/long periods), context (what were you doing, where were you); and finally, how severe it is (prevents you from doing what?) Typically the info is based on the pain scale 1-10 with 10 being the worst pain ever experienced

Always take an advocate with you: A friend or a family member It’s often hard to remember everything the doctor talks about during a visit because of the patient’s anxiety A second pair of ears can make a big difference in the end result

Take notes at the visit using your journal or have your advocate take notes

Ask specific questions like, “Is there anything I need to watch for, can you refer me to a specialist (Haupt, 2023 )?”

Ask for clarification if you don’t understand what they are saying.

Ask if there are other options or if this is the only one.

Request a summary of the visit at the end.

If you don’t communicate your concerns about the failed relationship with your doctor, how will they know? Be vulnerable even if it feels uncomfortable (Haupt, 2023) If you stay silent and don’t give them any feedback, how can they improve their relationship with you? This is especially difficult if your non-verbal communication and compliance says everything’s OK

Have you ever thought about your communication style? Have you ever told your doctor, “I don’t understand what you are telling me- can you explain that in plain language?” Be relentless and don’t give up easily!

You are entitled to say things like, “Doctor, can I be honest and transparent with you? I’m not happy with how this visit went, can we come to a mutual understanding so that I am participating in my own care plan?

Or something like, ”I would like to end today’s visit by resolving my biggest issue -how should we address this together without my having to wait a long time for a follow-up visit (Haupt, 2023)?”

Remember, doctors are all different and in time you will learn what is and is not significant for your doctor (Hester, 2022) However, they should all match what matters to you!

Look up Navigators in InformAlberta ca to help you navigate the Alberta Health System (all providers and services) This website is the best kept secret! T A K E A W A Y S

Be prepared to visit your doctor, do not just “wing it” Have your concerns written down in point form

Stick to the present concerns, don’t go back too far in your medical history

Talk to your doctor if you are not getting what you need. How will they know if you don’t tell them?

Keep a journal of your healthcare journey.

Consider buying the book “Patient Empowerment 101” by Ann Hester.

MyHealthRecords App

Open your phone’s camera and point it at the QR code below A yellow link should pop up Click it to be taken to the website to learn more

Keep a journal of your doctor visits, tests (blood, urine, x-rays, ultrasounds, scans), diagnoses, medications (doses, frequency, start/stop dates, interactions, side effects), and summaries or recommendations from each visit. Include referrals to specialists and have a separate page in the journal for each doctor. The journal can be organized in a variety of ways and Hester (2022) has some great ideas

Use Alberta’s MyHealthRecords to keep informed I cannot stress this one enough! This official Alberta Health online record is in real time and is invaluable for patients who want to self-manage their care or are participating in their care in concert with their doctor. The magical thing about your record is that you will get your results for tests done the day of, before the doctor does. This allows you to be proactive and make appointments to discuss abnormal results - you don’t have to wait for the doctor to call you.

The tests have links to myhealthalbertaca explaining what the test is for and the normal values Abnormal values are pointed out for you You can do a look back in time over a whole year in myhealthrecords to see if the values in your tests are improving or not; you can chart the results and print them off to discuss with the doctor on your next visit.

I like to keep an eye on my A1C because I am pre-diabetic, this way I can manage my diet and activity and keep my blood sugar from going higher I can talk to my doctor about diet and get a referral to a Registered Dietician if I choose Or I can go to the Diabetes Canada website where I can find lots of tools to help me manage my A1C

If all else fails, before you look for a new provider, let the doctor know what you experienced and how it made you feel. Only then can they improve their practice.

You can also notify CPSA and file a complaint online about a registered member (the doctor) if a very serious incident occurred

Finding a New Doctor

There are some things patients can do to set hemselves up with a doctor hey can work with and trust. When you set out to find a new doctor and make that nitial appointment to meet he doctor, the visit determines whether this is a good fit for the patient and for he doctor

Will the new doctor listen to your concerns (active istening) and give you ample ime to address them?

Did they explain your health concerns using language you could understand?

Did you feel respected, were you able to participate equally in the conversation regarding your care plan?

Did you feel heard (Fuehrer, 2024; Hester, 2022)?

Pick a doctor who has similar beliefs and values and who has the capacity to work with you to determine an outcome that both of you will find acceptable

You will want a provider who genuinely listens to you and accepts some of your suggestions so there is mutual participation in the relationship.

A doctor who does a check in with you and says, “Are you Ok, do you agree with me, how can I explain this better?”.

Find a doctor that might phone after hours to see how you are doing after a difficult treatment or procedure. Just that extra ‘above and beyond service’ goes a long way in developing a positive relationship. Maybe you are a caregiver looking for a doctor that does house calls for a homebound family member

When you need a new doctor, you can call 811 for a list of “doctors taking new patients”

You can also call:

The College of Physicians and Surgeons of Alberta at 780-423-4764

The Westview Primary Care Network at 780-9609533

Community Health Navigators (CHNs) provide navigation services to patients living with multiple chronic conditions CHNs are not health professionals (HPs), such as doctors or nurses, but they support the work of HPs by assisting with system navigation, self-management, and social connections.

You can access navigation services by: Using the website, www.informalberta.ca. This website provides a list of all Alberta Health providers and services You will find, FCSS of Stony Plain at 780-963-8583 for Stony Plain and Parkland County Bridging Connections Navigation Services provided by FCSS Spruce Grove 780-962-7618 for Spruce Grove and Parkland County

Note that FCSS has a new name: Community Social Development (CSD)

In summary, you are your own best advocate You have the choice to make the most of your present patient-doctor relationship and also know that you can find another provider who will work with you better (but if it’s not broke, don’t fix it as they say). Your voice matters and only when you become an empowered patient can you empower your family and friends to do the same (Hester, 2022).

Disclaimer:TheinformationinthisarticlewaswrittenbyVickieBoechlerBScN,MNandisintendedforinformationpurposesonly,nottogiveheathadvice Thisinformationdoes notreplacethehealthadviceofaphysicianoranyotherhealthcareprofessional

References: AlbertaCHN–AlbertaCommunityHealthNavigators;accessedonlineFebruary12,2025 AlbertaHealth (2014) AlbertaHealthCharter|Albertaca;accessedonlineFebruary12 2025 AlbertaHealth (ND) myhealthrecords;https://myhealthalbertaca/myhealthrecords;accessedonlineFebruary12,2025 CPSA (ND) Complaints-CollegeofPhysicians&SurgeonsofAlberta|CPSA;accessedonlineFebruary12,2025 Fuehrer,S,Weil,A,Osterberg,L,Zulman,D,Meunier,M,Schwartz,R (2024) Buildingauthenticconnectioninthepatient-physicianrelationship;accessedonlineFebruary12,2025 Haupt A (2023) 6thingstodoifyourdoctorisn’tlisteningtoyou Timecom; accessedonlineFebruary12,2025 Hester,A (2022) Patientempowerment101:Morethanabook,it’s anadventure Amazonca,AchesonAB ISBN:9798363626036 Peabody,F (1927) THECAREOFTHEPATIENT|JAMA|JAMANetwork;accessedonlineFebruary12,2025