The Intelligent Patient's Guide to the Doctor-Patient Relationship: Learning How to Talk So Your Doctor Will Listen

303 Pages·1998·13.38 MB·English

by  Barbara M. Korsch

THE INTELLIGENT
PATIENT'S GUIDE TO
THE DOCTOR-PATIENT
RELATIONSHIP
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THE INTELLIGENT
PATIENT'S GUIDE TO
THE DOCTOR-PATIENT
RELATIONSHIP
Learning How to Talk
So Your Doctor Will Listen
BARBARA M. KORSCH, M.D. & CAROLINE HARDING
OXFORD UNIVERSITY PRESS
NEW YORK OXFORD
Oxford University Press
Oxford New York
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Copyright © 1997 by Barbara M. Korsch and Caroline Harding
First published by Oxford University Press, Inc., 1997
First issued as an Oxford University Press paperback, 1998
Oxford is a registered trademark of Oxford University Press
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press.
Library of Congress Cataloging-in-Publication Data
Korsch, Barbara M.
The intelligent patient's guide to the doctor-patient relationship:
learning how to talk so your doctor will listen/
Barbara M. Korsch and Caroline Harding,
p. cm. Includes bibliographical references and index.
ISBN 0-19-512657-2 (pbk.)
\. Physician and patient. 2. Consumer education.
3. Interpersonal communication.
I. Harding, Caroline. H. Title.
R727.3.K67 1997 610.69'6—dc21 97-373
1 3 5 7 9 10 8 6 4 2
Printed in the United States of America
CONTENTS
ACKNOWLEDGMENTS, vii
POINT COUNTERPOINT
Listening to Both Sides, 3
SO, WHAT DID THE DOCTOR SAY?, 11
WHAT WENT WRONG?
Derailed Encounters, 34
WHY DON'T I FOLLOW MY DOCTOR'S ADVICE?, 69
WHERE IS THE TRUTH?
Secrets and Lies in the Doctor-Patient Relationship, 92
DOES YOUR DOCTOR SEEM UNFEELING?, 125
HOW DO DOCTORS GET THAT WAY?
The Conspiracy of Silence, 145
DO I HAVE TO GO TO THE DOCTOR?, 165
WHEN YOUR CHILD IS SICK, 195
THE HOSPITAL, 230
GETTING THE MOST OUT OF MANAGED CARE, 261
NOTES, 283
SELECTED READINGS, 287
INDEX, 289
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ACKNOWLEDGMENTS
This book is based on fifty years of experience in medicine. Patients, their
families, colleagues, and friends have all been my teachers. A large amount
of what I know and what I experience comes from reading—science, but
also important world literature, including fiction. It is not possible for me
to trace the sources and influences that have actually shaped my own
thinking.
Giving credit to selected individuals who have been significant in my
professional life would mean omitting others who have been equally influ-
ential. But I wish to pay homage to the late Loren Stephens, a wise and
sensitive teacher who inspired my interest and understanding of what
"doctoring" is all about and who is responsible for many of the ideas in this
book.
My colleagues at the Bayer Institute for Health Communication, es-
pecially Greg Carroll and Vaughn Keller, have been an invaluable resource.
I owe the reader an explanation regarding the case illustrations used
viii ACKNOWLEDGMENTS
I
in this work. The long dialogues come from literal transcripts of recorded
medical visits. Shorter quotes are gleaned from medical practice, mostly
my own, and sometimes that of colleagues as well as from the files of the
Bayer Institute for Health Communication.
We have had to review a great many publications and wish to thank
Doreen Keough, Health Sciences Librarian at Childrens Hospital Los
Angeles. There has been no reference, no matter how old or how obscure,
that she was not able to produce quickly.
There have been thousands of publications on the doctor-patient
relationship since the 1940s. We will not attempt to review the literature,
and cite original sources only in relation to specific research projects. For
the interested reader we have suggested a few from the many excellent
books that deal with the doctor-patient relationship in general. (See the
Selected Readings at the end of the book.)
Most of all, we owe special gratitude to our editor, Joan Bossert. She
has been a valuable collaborator throughout the preparation of this manu-
script. Her support, contributions, and constructive criticisms have been
invaluable. To our families and friends, especially Robert Ward III and
Harding B. Michel, Ph.D., we are grateful for their having encouraged and
sustained us during this work.
December 1996 B. K.
Los Angeles, California C. H.
THE INTELLIGENT
PATIENT'S GUIDE TO
THE DOCTOR-PATIENT
RELATIONSHIP