Amber Taufen, a 33-year-old freelance writer and editor in Denver, Colorado, was surprised to learn at age 25 that she had high cholesterol. Taufen had gone to the doctor six weeks after her father died to get a prescription for the anti-depressant that her grief therapist recommended, and her blood work showed that her cholesterol was in the upper range of normal for her age. Taufen's doctor wanted to put her on Lipitor, a statin drug that's used to lower cholesterol. It can have side effects such as diarrhea and weight gain, and the doctor suggested that Taufen should be on it for life.
"It seemed like an extreme measure," Taufen says. She asked the doctor about alternatives -- like lifestyle modifications including regular exercise and a healthier diet. "[The doctor] said, 'No, I think this is the treatment plan you should be on.'"
At 25, Taufen says she didn't feel confident enough to voice her disagreement with her doctor. So she quietly walked away, and changed her diet and started exercising. "My results have been pretty impressive," Taufen says. "My current physician thinks there's never any reason for me to be on a cholesterol drug."
In retrospect, Taufen says, "I wish I would've told [the first doctor] outright that I was going to leave her practice. And maybe if she'd heard that, she would've opened up."
The experience, Taufen continues, "Made me a lot more selective about my choice of care provider. After that I've not gone to a physician without a personal recommendation."
[Read: What Your Doctors Wish You Knew.]
First Impressions are Crucial
Striking the right chord in your relationship with your doctor is important, and as with most relationships, first impressions count. "The first 15 seconds of your interaction with a patient really set the tone for your experience," says Melissa Musiker, a communications and policy strategist based in the District of Columbia and dietitian who was formerly a consumer member of the District of Columbia Board of Medicine, where she fielded a lot of patient complaints about doctors.
The vast majority of complaints, Musiker says, boil down to the larger issue of miscommunication. "Choice of words, tone, mannerisms impact how you [the doctor] are understood, and how willing a patient is to accept your advice," she says. " Listening is critical as well."
Health care is increasingly a service being provided to consumers, so doctors -- and all health care providers -- should attenuate their behavior accordingly, she adds, comparing the sector to retail. "I don't want to go to a clothing store where the sales girl is snotty."
Giving off the wrong signals can lead to disagreements, which in turn can become patient safety issues, some of which may cause the rate of hospital readmissions to rise, Musiker continues. But hospitals are now incentivized to lower readmissions -- because of new Centers for Medicare & Medicaid Services regulations that reward hospitals financially for lowering readmissions. "That makes it even more critical in any kind of care setting to limit that kind of [patient and doctor] disagreement," Musiker says.
But sometimes doctors and patients just don't see eye to eye about diagnoses and treatments, Musiker continues. In her experience as a dietitian, she saw a lot of obese patients who wouldn't point the finger at their own lifestyle problems as the root cause of their condition. "You'd hear all about their eating and could really quickly diagnose the problem ... as drinking a gallon of soda a day," Musiker says. "You say that and they say, 'No, I just have a slow metabolism.'"
Musiker had a lot of pediatric patients, where working with the parents was oftentimes a real challenge. She would suggest the family switch to one percent milk over whole, and dilute juice with water. "Some parents would think that was great. Others would say, 'My kid has a slow metabolism. My whole family is big,'" Musiker says, adding that instead of giving up on the parents, she would ask follow-up questions -- like "What can we do to help your child?" -- that invited collaboration and built the rapport so the parents would be open in the future to her advice.
"You [as a health care provider] can't always get your way, even when you're right," Musiker says. "But if you butt heads, you're going to lose."
[Read: What Your Doctors Wish You Knew.]
Dealing With the Well-Informed Patient
Health in the Internet age is a double-edged sword: Patients know more, so they can be more active participants in their care; they are also more misinformed, leaving health care providers frustrated. "A doctor will say, 'A half-educated patient is the worst kind of patient,'" Musiker says, adding that the "pediatric mom" is another problematic paradigm.
Regardless of who patients are or who they're representing, if they come to the doctor with a closed mind, the doctor will be put off, says Trisha Torrey, a patient advocate and director of her own consultancy called "Every Patient's Advocate." "In effect the patient is saying, 'I know you spent 15 years learning to become a doctor, but I spent an hour on Google.'"
Instead, Torrey suggests, patients should read everything from credible sources they can get their hands on. "Then when you go to the doctor, say, 'I read about this. Can you tell me if this is good for me?'" Patients can also submit a list of questions to the doctor before their appointment, she adds. "A meeting of minds takes place more through listening and questions than it does through speaking."
Doctors, too, need to go into patient visits with an open mind and open ears -- and be armed with probing questions instead of just those that elicit "yes or no" responses, Musiker adds.
But as with any relationship, your relationship with your doctor may not be meant to last, she says. "If you reach a point where you realize you cannot have a positive interaction, know when to say, 'This is not working.'"
"It could be that you want to stick to your guns, and if you need to, you can go to another doctor and start all over again," Torrey adds.
[Read: When to Fire Your Doctor.]