A Doctor's Point of View on the Doctor Patient Relationship

How do you feel disagreements between doctors and patients should be handled?

I try to avoid the disagreements in the first place. I am not confrontational in my approach. I give the patient time to have their say and listen to their concerns and complaints. The philosophy which has always guided me in my life has being to remember that it is the patient who is suffering. They are the ones who feel vulnerable and hence may be defensive or confrontational at times. As a physician I have learnt not to take it personally. The idea is to work as a team towards a common goal of getting back to health and not to be at each others throats.

Why is that some doctors dismiss alternative therapies to treat illness?  How can a patient bring up the fact that they may use alternative treatments without feeling dismissed?

That question is easy to answer. The reason why many of us allopathic doctors dismiss alternative and complimentary therapies (as they are referred to now) is because we are not exposed to them during our training. Let me explain with a simple example. If during my training and practice, I have never been exposed to the use of acupuncture or massage therapy for the fatigue associated with multiple sclerosis, how can I trust that it works and recommend it to my patient? Medicine is a science and art honed after years and years of training. One learns what works and what does not and then we as doctors stick to it. I am not saying alternative and complementary medicine does not work, I am saying I do not have knowledge to say if it works or not.

One reason for this skepticism is that many who practice alternative and complimentary therapies have not subjected these therapies to double blind random studies. Let us take an example. Suppose someone says that a herb works for multiple sclerosis, well then prove it. Test it on patients. Give it to patients in a blinded fashion and see if it works. Publish those results so others in the scientific community can review and critique it. But unfortunately there is no effort to do this by people who practice these different systems of medicine.

On a more personal note, I am not averse to my patients discussing alternative options and therapies. I keep an open mind and am humble to realize that is much I do not know. But I try to make sure, that the alternative therapy they try shall not harm them.

What do you feel is the most common reason for a patient to stop going to see their doctor?

Again I feel that every doctor patient relationship is unique. There are multiple reasons patients may be lost to follow up. They did not like their doctor, they did not like what the doctor told them to do, they did not like his office staff, they had to wait too long for their appointment, financial constraints or the fact they are still in denial are among other reasons patients may stop seeing their doctor.

In your opinion, when is it a good idea for a patient to get a second opinion?