Managing the Power Dynamic Between Doctors and Patients

Managing the Power Dynamic Between Doctors and Patients


Feeling powerless is one of the worst side effects of coping with a medical condition, and the last thing you need is a power struggle between you and your doctor. If you feel like less than an equal partner in your own health care, certain strategies can help restore balance.

You Know There’s a Power Imbalance When …

“If you walk into the doctor’s office and you feel intimidated, trust those feelings,” says Michael Greenberg, a dermatologist in Elk Grove, Illinois. When a doctor projects arrogance and you feel uncomfortable, that’s a key sign of trouble to come.

Patient advocate Trisha Torrey, author of “You Bet Your Life: The 10 Mistakes Every Patient Makes,” says another sign is meeting some sort of resistance whenever you ask your doctor a reasonable question. The same holds true if your doctor discourages you from seeking a second opinion.

On the flip side, asking for referrals can be tricky when doctor-patient trust is lacking, Torrey says, because you don’t know how objective the second opinion might be. So do some investigation on your own.

When you don’t get enough airtime during an office visit, that saps your power.

It takes an average of roughly 23 seconds for doctors to interrupt when patients are talking, Torrey says. “You feel that you’re not being heard, and assumptions are being made that may or may not be true about you,” she says. But “you can re-engage the doctor and say, ‘Look, may I finish my list?’”

If you need extra support in speaking up, consider taking a family member, neighbor or patient advocate along to your next appointment.

No Pedestals, Please

Even with the ongoing movement to empower patients, some still fall into worn-out roles where doctors dominate and patients remain passive. “Treat your doctor the same way you treat any other professional,” Greenberg says. “Certainly with respect for the title – but respect doesn’t mean subservience.”

When patients ask him if he could “answer a quick question” or “take a quick look,” he tells them, “You know, we doctors have so socialized you to think our time is so valuable that you beg for time from us.” Talking that way only feeds into that perception, says Greenberg, who wrote “Off the Pedestal: Making Medicine Work” more than two decades ago.

For her part, Torrey sees a generational shift in the way patients perceive doctors. Adults in their 70s and older are “still very much about the doctor is God,” she says. “But baby boomers and younger – not so much.”

Waiting Rooms: Putting the Patient in ‘Impatient’

Time is power, and sitting and stewing in the waiting room can be power depleting.

Of course, emergencies arise or other patients need more than the 10 to 15 minutes allotted them. But you can take some control. When you first walk into the waiting room, go ahead and ask if the doctor is on time, Torrey advises. If you learn they’re running an hour behind, you can choose to say “I’ll wait” or ‘I’m going to need to reschedule.”

In some cases, she says, you may be able to request a long appointment when you call in to schedule, depending on your needs. The doctor can then give you more time and bill the insurance company accordingly. (This may only apply to certain states, insurers and types of practice, she notes.)

Who Wears the Pants?

Everyone hates medical exam gowns. They’re flimsy and revealing, and they gap in the worst places no matter how you tie them. While the gown is a necessary evil, it puts you at a disadvantage when you’re discussing the treatment plan with your fully clothed physician.

Many doctors give you a chance to dress after the exam before returning to talk ­– but if not, Greenberg says, ask for five minutes to pull yourself back together.

White coats – and senior doctors get the longest coats – can be subtle signals of the doctor-patient power imbalance. In his practice, Greenberg doesn’t wear a white coat, and he says patients notice. They also appreciate that he introduces himself to them as “Michael” instead of “Dr. Greenberg.”

Doctors who practice in less affluent communities might want to tone down obvious displays of wealth or status in their work attire. For example, guidelines from the University of Michigan’s Program for Multicultural Health advise physicians to be mindful about wearing expensive jewelry.

Emphasis on Empathy

Doctors can help patients feel safe and more in control, even when they’re physically or emotionally vulnerable during a visit.

Sheila Patel, medical director of the Chopra Center in Carlsbad, California, says when patients walks in her office, the first thing she does is engage in friendly banter. “I ask them some personal questions, maybe make them laugh – you know, feel comfortable,” she says. “And then we move into the physical exam.”

A little empathy goes a long way, and both Patel and Greenberg say they treat patients the way they’d want their own family members – or themselves – to be treated.

Knowledge Is Power

Doctors have the medical knowledge but you’re the one who knows your body the best, Torrey says. “So if you understand what seems right and what seems wrong with your own body, then you know when to push back a little back and say, ‘You know, this just isn’t working,’ or ‘I’m not sure you’ve answered my question.’”

Talking above patients’ heads can make them feel powerless. When doctors simplify medical jargon like “calcaneus” to “heel bone,” that helps. Also, talking at eye level and making eye contact can improve the doctor-patient interaction.

The Internet has shifted some knowledge power toward patients, who are now likely to have researched their symptoms, located a variety of treatment options and have the pile of printouts to prove it.

But instead of putting doctors on the defensive with a wad of information, Torrey suggests saying something like, “‘I read about X – can you tell me how that would or wouldn’t apply?’ Now you’re not in an ‘in your face’ [attitude],” she says. “And I think doctors will often hear that better.”

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