Physician and patient: A complicated relationship

The doctor-patient relationship isn’t always easy. On the one hand is the physician, who is responsible for helping many patients. On the other hand is the patient, who visits the doctor in the hopes of his or her problem being treatable. Things always get difficult when one of them feels that they don’t see eye-to-eye. And this happens a lot.


Photo: Christiane Lange

Christiane Lange, Expert healthcare market; ©Verbraucherzentrale NRW

People like to say that things were a lot easier in the past. Even going to the doctor. The patient got there and described what ailed him; the physician determined the right treatment, told the patient and subsequently administered the treatment. Today it seems that physicians and patients frequently irritate each other. The patient visits the doctor, receives her diagnosis – and vehemently objects. After all, she knows exactly what ails her, because she has researched online before coming to the doctor. Compliments of “Dr. Google“.

It is hard to separate the wheat from the chaff

If you want to get information about symptoms when you are sick, you typically search the Internet. The problem: a search engine delivers a results page that’s sorted by keywords and not by how reputable the information is. What’s more, a symptom like headaches for example, can have many different causes, ranging from stress all the way to a brain tumor. That’s why the information actually doesn’t usually help the patient much without an accurate diagnosis. If you want to be sure, that a website is at least based on reliable information, you can look for the HONcode of the Health on the Net Foundation or call up the websites of patient guides. Their lists of links are generally certified and lead to reputable sites. However, truly valuable information is only a given when you discuss the research results with an expert. And this continues to be the respective medical specialist.

Photo: Patient talking to his doctor

You give me time, I will give you trust. This is how you could sum up a doctor-patient relationship. The reality is different. As a patient, you need to be quick if you want to describe your discomfort, since the physician interrupts you after an average of 15 seconds; ©

Patient or customer?

The patient-physician relationship is further complicated in Germany by the fact that medical practices at this point offer different benefits as self-pay services, the so-called IGeL services (Translator’s remark: Igel in German means hedgehog). Oftentimes, they are the reason people are upset. Christiane Lange from the Consumer Advice Center of North Rhine-Westphalia (German: Verbraucherzentrale NRW) in Düsseldorf confirms: "The Consumer Advice Center keeps getting complaints from patients about IGeL. But there was no systematic data collection. This is why we started a survey on this topic in 2012. The outcome was that many patients feel poorly advised." She adds: "Some patients receive flyers or lists right when they come into the office. They are then asked to read them in the waiting room and check off which treatment they would like. However, this doesn’t replace the mandatory medical consultation where I am being fully informed as a patient."
Photo: Stethoscope lying on dollar bills

Individual health benefits are not covered by German statutory health insurance companies, since their effect is questionable or not clearly determined yet and not, because health insurance companies don’t want to pay for therapies due to lack of funds; © Vichaya Kiatying-Angsulee

That’s reason enough for consumer advocates to create a web page patients can use to file consumer complaints. At www.igel-ä you can post your experiences to the bulletin board; the editorial department also responds to some comments. The tenor of most entries: there is not sufficient information that’s being provided; the appointment depends on whether an IGeL service is being booked at the same time; or you are being told an IGeL exam is urgently needed to reach a diagnosis. Lange does not accept the objections by physician representatives stating these are all rotten apples: “I simply cannot relate to the arguments by physicians that these are allegedly individual cases after I have seen a thousand complaints on our web page.“ She suggests that patients should get informed to avoid trouble. However, she admits that apparently this isn’t always enough. “Many patients report that even though they got informed, there was no benefit since the physician is very critical and feels his/her medical skills are being questioned. This results in the doctor not viewing the patient as a partner, with whom he or she exchanges information. Even though there is some rethinking at this point, patients still need to overcome many obstacles that should not be there anymore.“

Generally, if you don’t feel you are taken seriously or are treated poorly as a patient, you need to look for a different physician. This can pay off, because this is about your very own health and often about a lifelong relationship when the chemistry is right. This is a win-win situation for both sides.

[1] Wilm S, Knauf A, Peters T, Bahrs O. Wann unterbricht der Hausarzt seine Patienten zu Beginn der Konsultation? Z Allg Med 2004; 80: 53–57 (in german)
Photo: Simone Ernst; Copyright: B. Frommann

©B. Frommann

Simone Ernst