Guest Post by Anne Polta author of the blog HealthBeat.  Thanks for covering Anne while I am off having my third Vitrectomy to repair yet another detached retina.

To be clear, there are lots of great clinicians out there. I’ve met many of them and I know them to be hard-working, dedicated and caring.

If the focus of this discussion is on doctors, perhaps it’s because this is the relationship that’s central for most patients and one that they view as important.

I think a lot of this really does come down to medical culture – the attitudes, values and beliefs that have become so engrained that they’re not even visible to many clinicians, let alone questioned. For starters, look at the language that’s used – “problem list,” “chief complaint,” “doctor’s orders,” “the patient failed treatment” and so on – all tending to reinforce the patient’s role as subordinate/supplicant. Whether we realize it or not, perceptions shape the words we use, and the words we use are at least partially shaped by our perceptions and attitudes that the patient isn’t equal to the clinician.

Here’s another example: information-sharing. Do you routinely share the specific details of test results with patients, or do you tell them “everything was normal” and then wait for them to ask for the details? How often do nurses take the patient’s vital signs and silently write down the results without sharing them? There is a difference between “we’ll share the information if the patient asks for it” vs. “we’ll routinely volunteer the information because the patient has a right to know” and it lies in the mindset that there’s a presumption from the get-go that the information will be shared.

Don’t even get me started on the whole issue of adverse events and disclosure. I have unfortunate personal experience with this, and I’ve had to accept the fact that no one is ever going to tell me what really happened. How are patients supposed to be more involved and more responsible for their health when the playing field is so uneven?

It doesn’t take more time to make some of these changes. You could develop a policy that patients will automatically receive complete test results. You could streamline your processes to make it easier for patients to obtain copies of their medical record. You could post signs at the reception desk or in the exam room, or slip a notice in with the bill, informing patients of what the process is to obtain their medical information. It’s about being more transparent and sending a message that it’s OK, and even encouraged, for patients to ask.

Compared to 10 or 15 years ago, I think the system actually is getting better at this. We’re in a transition right now, and transitions often are difficult. It’s hard to have the conversation without clinicians getting defensive and patients getting frustrated.

I don’t want to take on the doctor’s role; I’m not smart enough for that. I’d just like to see a partnership that’s a little more 70-30 or 60-40, instead of 95-5.