Do you ever go to the doctor's office for something and leave feeling like you got totally steamrollered? You might have received what you needed, kind of, but you didn't get the information you wanted, you're wondering what other options might have been available, and you're worried that you might be missing vital data about side effects and risks. Do you go home and Google it, hoping for the best, or do you turn around and demand another appointment so you can get some straight facts?
Talking to doctors is intimidating. There they are with their big white coats and embroidered names and fancy titles, and they seem so authoritative and knowledgeable. They've spent years in medical school learning how to practice medicine, and they carry an air of knowing what they're doing, and knowing what's best for you. Patient self-advocacy can feel like defiance, when really, it's about wanting to know more about your medical treatment.
A recent study in Contraception took a look at the differences between what patients want at appointments for birth control, and what doctors provide. It's a great example of a common medical appointment that takes place on a daily basis in doctors' offices all over the US, and it highlights the huge disconnect between doctors and patients.
Here's what doctors think patients want when they come in seeking information on birth control: data on efficacy, and coaching on how to use birth control properly.
Here's what patients actually want when they come in: information on safety and side effects, and education about how birth control actually works.
Why aren't these needs meeting in the middle? I'd argue that patient fear of doctors is a huge part of it, because people are often intimidated when it comes to asking questions in the doctor's office. Part of that is simply an ingrained respect/fear of people in authority, but it's also often the result of previous interactions in medical settings, where doctors are sometimes brusque or dismissive with patients who request more information. In that context, it makes sense that patients might be wary of engaging with their doctors.
There's also the limited amount of time for medical appointments. Doctors are being urged to take shorter and shorter appointments so they can pack patients in during clinical hours, and thus, they don't have the time to properly sit down with patients, address their concerns, and try to discern issues that patients might be reticent about discussing. Patients who aren't willing or able to self-advocate are left in the dust.
Self-advocacy is something that needs to be learned. It's not an innate skill. Patients who don't regularly interact with the medical system may miss opportunities for learning, and may not think they need to acquire self-advocacy skills. Yet, they come in incredibly helpful in even routine settings, as illustrated here, where patients are not getting what they want and need out of birth control consultations.
Learning self-advocacy before you need it prepares you for when you do. For when your parents are in the hospital, for example, and they need someone on their side to interact with practitioners. Or for when you're facing an unexpected medical crisis and you're sucked into the depths of the medical system. The more you learn and practice it, the more you'll be ready to use it, and this is a perfect example of a setting for practicing self-advocacy skills.
But the burden here shouldn't be entirely on patients. Yes, self-advocacy and active involvement in care are important (and studies demonstrate that patients who are actively involved tend to have better outcomes), but they aren't the only thing. Care providers need to be paying attention to the needs of their patients in order to rethink how they present information to patients at medical appointments.
Studies like this one show the value of polling to help doctors shape patient care, but they're not the whole story. While I hope that providers are taking notes from this study and adjusting their birth control consultations accordingly, it's notable that this was an Internet-based poll. The participants were primarily white, middle-class, and in a position to use the Internet for medical studies. Not, in other words, a widely representative sample of women seeking birth control.
More comprehensive studies are needed to explore what women from different walks of life might be expecting from birth control appointments, and how to accommodate them. Fine-print warnings are notorious for being read only by the recycling bin, and it behooves doctors to sit down with patients and talk about fears, side effects and risks, even if the primary outcome is simply to assure the patient that adverse events are extremely unlikely (as, indeed, they are).
Let's face it: Birth control is still stigmatized in the US, and that's bound to make patients uncomfortable when asking for information, especially if they're, say, having to wade through anti-choice jerks to get into a medical clinic. When the shouts of screaming protesters are ringing in your ears as you request birth control, you're not necessarily operating from a cool, level-headed, focused place that allows you to ask your doctor for more information. This needs to be acknowledged when talking about how to improve communication on birth control and other reproductive health issues, as silence can, in some cases, lead to serious implications for the patient.