How and Why to Be a Good Patient

The hot flashes were constant, sweat pouring off me at the most inopportune moments. Sitting in a gynecologist's office after my exam (during which he told me I was "dry as a well-gnawed chicken bone" – thanks, doc!), we talked about pre-menopause, which it was called then, and he suggested hormone replacement therapy. I said I had recently read that estrogen could cause breast cancer, and he impatiently replied, "Look, hon, I'm the doctor. I recommend estrogen for almost all of my women patients. If you have a problem with that, maybe I'm not the right doctor for you."

He certainly is not, I thought, grabbing my purse and exiting. I wasn't a "good" patient, and thank goodness I wasn't. Shortly after that, the news broke that there were health risks associated with taking estrogen, particularly when it was given without progesterone, for women – like me – who still had a uterus. Lesson learned? If the job description for a good patient means blindly accepting a doctor's recommendations, it's not a job I want. 

In the 1950s, when my mother's OB-GYN put her to sleep and handed her a perfect newborn (me) when she woke up, the excellent patient was obedient, passive, and willing to comply. This went along with the then-popular paternalistic model of physician-patient relationships when doctors determined what they believed was best for the patient.

Patient autonomy or informed decision-making was not in anyone's vocabulary in those days. Today, positive doctor-patient interaction is collaborative, geared toward helping patients assess their beliefs and priorities to make the best health-related decisions feasible within the clinical situation's parameters.

The "good patient persona," therefore, has been described variously as someone who listens carefully, asks relevant questions, follows through on jointly-agreed plans for medications, procedures, or lifestyle changes, expresses appreciation, shows confidence and trust in the health care provider, and has a good attitude (which probably means not blowing up if the average 15-minute wait for your appointment has more than doubled.) 

Interestingly, men, who, in my experience as an RN and clinical social worker, tend to ask fewer questions and rarely make suggestions concerning their treatment, may more often be viewed as "good patients." But moreover, I know that it is possible to be a good patient and to still be true to yourself, honoring and respecting your strengths while being open to getting your physician's input and appreciating their breadth of knowledge and insight.

You have a health care provider you like, respect, and trust. Likewise, you hope they will like, respect, and trust you. So how can you create a mutually satisfying and productive relationship? Perhaps the most important thing to do is what you say you're going to do after you've agreed to do it.

The best way to create a mutually productive and satisfying relationship is to adhere to your doctor's prescription regimen. Medical adherence is "the act of filling new prescriptions or renewing prescriptions on time," while medication compliance is "the act of taking medication on schedule or as prescribed."

Unfortunately, studies show that 20-30% of prescriptions are never even filled, and a survey of adults 40 and over, sponsored by the National Community Pharmacists Association (NCPA), found that among people prescribed ongoing medication for a chronic condition, about 28% of patients failed to refill a prescription on time. It also showed that 22% took a lower dose than prescribed, and 14% stopped taking their medication altogether.

Reasons for not taking medications as prescribed include cost, difficulty tracking refills, fear of side effects, and stopping medications either because they didn't seem to be working or because they felt better and no longer needed. Adherence also encompasses how well you follow your health care provider's recommendations concerning diet, exercise, scheduling tests such as an MRI, or when to come back for a follow-up appointment. Poor adherence can lead to hospitalizations, health complications, rapid disease progression, increased health care costs, and even premature death.

Good patients tell the truth! Surprisingly, two extensive national surveys found that 60-80% of those queried admitted they had not been forthcoming with doctors about information that could impact their health status.

Another study of people with Medicare Advantage plans found that 47% had lied to their doctors about their diets, exercise habits, alcohol intake, sex lives, or treatment adherence. Patients fudged the truth primarily out of embarrassment or because they didn't want their doctor to lecture or judge them. 

Unfortunately, this behavior prevents health care providers from getting an accurate picture of what's going on medically and may cause them to change treatment plans or add new medications that are unnecessary or even dangerous.

In a personal, in-person interview with Laura Miller, an RN from Oakland, New Jersey, she suggested several ways to enhance the patient-doctor relationship. As an RN myself, I know how helpful these can be. Miller's insight is as follows:

• Bring a list of your current medications.
• Understand how your patient portal works on your smartphone and know whatever passwords are necessary.
• Prepare your "elevator pitch" – a brief statement about the onset and duration of symptoms, how you've tried to treat them, and the results.
• Bring a list of questions and write down the answers, plus any new directions. Then, before you leave, clarify them: "I'm supposed to take the medication three times tomorrow and then switch to twice a day, correct?"
• It's okay to let the physician know you've done some research but don't be upset if your favorite website doesn't agree with your doctor. Likewise, it's fine to ask for clarity as to why a particular treatment or test is being recommended.
• Don't tell your doctor what medication to prescribe. Thanks to the ubiquitous direct-to-consumer (DTC) drug ads seen on TV, billboards, and online, we're all experts on the latest and greatest ways to treat everything from heartburn to hair loss.
• If you're not sure about something, ask. It's much better than calling later that night and asking for a return call.
• Be nice to everyone you contact, and express your appreciation for their care, concern, and competence.
• For a successful telehealth visit, says Miller, sit in a quiet, well-lit location with the TV off and as few distractions as possible. Wear your hearing aids or glasses as needed. If possible, have someone with you to hold the video device in case the doctor needs to see you walk.
• Avoid what health professionals call "doorknob comments," which means leaving the most salient information to the end of your visit. An example? "By the way, doctor, I meant to tell you that my foot was green when I woke up this morning and had little purple polka dots all over it. What do you think is wrong?"

Listen to your doctor, communicate your thoughts and feelings clearly and calmly, and walk out with a mutually agreed-on plan to get you feeling well again. Do what you're supposed to do (be compliant and adherent), and your reward will hopefully be a clean bill of health and a better quality of life.

Barbra Williams Cosentino RN, LCSW, is a psychotherapist in Queens, N.Y., and a freelance writer whose essays and articles on health, parenting and mental health have appeared in the New York Times, Medscape, BabyCenter and many other national and online publications. Read More