The Educated Patient

Taking a Risk with a Chronic Condition

Power Dynamics and Communication Strategies

Why do you need to know about communication strategies and power dynamics when working with your physician? Because there is an absolutely fundamental power imbalance between the patient and the doctor. They have the power and you don’t. They have the knowledge and institutional authority, and you don’t. At an appointment, you may start telling them about why you are seeing them, and they interrupt to tell you what they think is wrong with you. Try asking them a question about alternatives to pharmaceutical based medicine. They may ask where you went to medical school.

The unfortunate truth is, a patient who asks questions can be managed more easily by a doctor who doesn’t tolerate them. It can sometimes feel like bullying behavior because it is fundamentally disrespectful to you as a patient and you can sense it. You deserve respectful consideration of any and all of your attempts to problem solve because you are both team members working on the same problem; your health. Not all doctors will try to use this as a time management strategy, but too many of them do because it works. Most patients are too intimidated to speak up for themselves. You need some communication strategies to re- balance power dynamics.

How to Manage the Power Dynamics

Prepare for each and every medical appointment. Write down your questions ahead of time, and highlight the top three questions you want answered. Be respectful but persistent. Insist on being heard. Refuse to take offense. It’s not usually personal. Your physician is not a substitute for a counselor, so find a counselor if you need one. You should expect respect and support, but your physician is a busy person and can’t be everything you need. Bring a support person if needed so you don’t miss anything important. Do your research ahead of time so you know what questions to ask.

Become an educated patient and a trusted team player on the healthcare team. You can ask for an appointment at the end of the day if you think you might need more time than usual, or if you have multiple issues. Try to understand that most medical practices are very busy with ten minute appointments being the norm. This makes your doctor a busy person, not a bad person. Understanding this can go a long way to improving the relationship.

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