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Developing a Good Doctor-Patient Relationship

When her first baby was born, Laura Goyer, of Vienna, Virginia, had an obstetrician she loved. He patiently responded to all of her questions, and if he didn't know the answer, he seemed eager to learn something new. "Once, he sent me eleven articles that he'd read and summarized for me," she recalls. "I really felt I could trust him."

She wasn't as lucky the second time around. Before becoming pregnant again, Goyer had changed insurance companies, and her doctor wasn't in the new plan. Though the group of five physicians she chose came highly recommended, a nurse's comment led her to believe that the doctors might not respect her belief in natural childbirth. She briefly considered switching to another practice but decided to talk to the doctors about her concerns instead. "Eventually, I developed a very good relationship with two of them-including the one who delivered my baby," she says. "But if I hadn't been proactive, I doubt things would have ended as well."

Having a doctor you feel comfortable with is always important. But, as Goyer learned, establishing a partnership is particularly critical during pregnancy and childbirth. If you're generally healthy, these months may mark the first time you've had such intense, ongoing contact with a medical professional. And that contact comes at a point in your life when you may be feeling anxious, unsure, excitable, and overwhelmed.

The key to ensuring a good experience lies in establishing a rapport with your doctor early on. In fact, experts say that miscommunication is at the root of almost all doctor-patient conflicts.

From the start, you should discuss the kind of birth experience you hope to have, suggests Nancy Levine, M.D., associate professor of family medicine at the State University of New York at Stony Brook.

"It's important for a woman to feel that she's contributing to the care she's receiving," says Janet Lobatz, a certified nurse-midwife and a founder of The Maternity Center, in Bethesda, Maryland. "The biggest problem is either the doctor not hearing what the patient is saying or the patient not being explicit enough." A study done at the University of Chicago Medical Center suggests that a major reason patients with "bad outcomes" sued their doctors was how their doctors had talked to them.

Unfortunately, because of managed care, doctors and patients may not have as much time during prenatal visits to get to know each other, notes Barbara Korsch, M.D., professor of pediatrics at the University of Southern California School of Medicine, and author of The Intelligent Patient's Guide to the Doctor-Patient Relationship (Oxford University Press). And if you alternate between several doctors in a group practice or HMO, there may be even less of an opportunity to build a trusting relationship over time.

Your expectations, however, need to be realistic. It's certainly reasonable to assume that your doctor will respectfully listen to your questions and concerns, says Dr. Levine. Your doctor should be easily accessible in emergencies, willing to return your phone calls within the hour if there's a serious problem, and prompt in letting you know about test results.

It's unreasonable, however, to think that a busy doctor will behave like your mother, therapist, or best friend. And although you may decide to write a birth plan, it's impractical to expect that you'll be able to control every detail of your pregnancy and delivery -- complications can foil even the best-laid plans.

Thanks in part to the Internet, which has made medical information more accessible, women are becoming better educated about pregnancy and want to be more involved in their care, notes Barry Egener, M.D., medical director of the Northwest Center for Physician-Patient Communication, in Lake Oswego, Oregon. Conflicts sometimes arise, though, when patients bring on-line material about alternative therapies -- such as herbal treatments for morning sickness -- that haven't been proven safe or effective for pregnant women, says Yvonne S. Thornton, M.D., director of the Perinatal Diagnostic Testing Center at Morristown Memorial Hospital, in New Jersey. You can certainly ask if your doctor has heard of a particular remedy and if she thinks it's worthwhile trying, but remember that not every treatment is appropriate for every patient.

Here are some other suggestions to help you establish a good working relationship with your doctor:

Prepare for each visit. Ask yourself what you want to get out of each consultation. It's helpful to jot down your concerns between visits and make a concise list of questions to bring to your next appointment. Take notes on what your doctor says because it's easy to forget her answers once you get home.

Don't withhold information. "Communication is a two-way street," says Dr. Thornton. It's crucial to tell your doctor everything she needs to know. Some patients are embarrassed to talk about their bad habits, such as smoking, "but this information can be vital to making decisions about your health," says Dr. Thornton.

Get your husband involved. Ideally, your partner should meet your obstetrician long before you're in labor so they will have time to get acquainted, says Dr. Levine.

Speak up. Don't hesitate to tell your doctor that you're dissatisfied and give him the opportunity to correct the problem, advises Dr. Egener. For example, you could say, "I have some concerns about why you're suggesting this approach." Be candid about what's troubling you-but not accusatory. "Sometimes the strongest relationships evolve when people have a heart-to-heart conversation," says Dr. Egener.

That's what happened with Laura Goyer. She chose two doctors in the group practice as her primary and backup physicians and made extra efforts to communicate with them. She also gave all of the doctors in the group copies of her birth plan, which specified, for example, that she didn't want to receive any drugs unless absolutely necessary. By the time she delivered, Goyer had confidence in her doctors' abilities, and she was pleased with the way they had handled her medical care and the birth of her son, Michael, last September. "If I ever have another child, I'll definitely trust them," she says.

  • Make sure that the new doctor you've selected will accept you as a patient and is covered by your insurance plan.
  • Inform your current doctor of your decision to switch. You might ask if he'd be interested in knowing the reasons for your dissatisfaction, suggests Barry Egener, M.D., medical director of the Northwest Center for Physician-Patient Communication, in Lake Oswego, Oregon. This gives him a chance to learn from his mistakes as well as an out if he'd rather avoid a confrontation. You may prefer to write a letter instead of calling or meeting with him.
  • Ask your current physician's office to forward all of your records to your new doctor. It's important to provide access to your complete medical history, including test results, any problems with the pregnancy, and any medications you may be taking.

Copyright © Michele Pullia Turk 1999. Reprinted with permission from the March 1999 issue of Parents magazine.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.