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Build a physician-patient relationship on trust, comfort

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Monday, Oct. 5, 2009

Ed Bednar credits his doctor, and the good relationship he has with her, for saving his life.

Recently, when Bednar was being treated for a few infections, his doctor -- Dr. Vidya Szymkowiak in Natrona Heights -- insisted that he go have his heart examined at a hospital, as a precaution. A day later, Bednar, now 76, was recovering from an emergency triple-bypass surgery.

"I can tell her anything," says Bednar, of Tarentum. "Even if it's a minor little thing, she listens, and if there is something wrong, then she prescribes something for it.

"If you can't talk to your doctor, you might as well forget it," he says. "Don't even bother going in."

Doctors, as the guardians of health and well-being, want to treat their patients as best they can, while patients want to receive the best health care they can. It's a mutual desire, physicians say, that is met when the doctor-patient relationship is based on comfort, openness, respect and especially good communication.

"I think that everybody wants to have a good relationship," says Dr. Bob Arnold. He is an internal medicine doctor at the University of Pittsburgh, where he often lectures on doctor-patient relationships. "The patients want a good relationship, and the doctors want a good relationship."

One of the barriers to good doctor-patient communication is the patient's fear of being judged, Arnold says.

"That isn't what doctors are about," he says. "I would argue that if you don't trust that your doctor wants to help you, and you don't feel comfortable, you ought to think about whether it's the right doctor for you."

That fear of being judged, and a resulting lack of honesty, can affect a patient's health, he says.

Doctors, for instance, could put patients on an overly high dosage of medication if a patient lies and incorrectly claims he or she is taking a drug as prescribed.

"I would rather have a patient be honest with me than have me be frustrated because I can't figure it out."

Dr. Carol Fox, a family physician and interim chief medical officer for Excela Health in Westmoreland County, says it's important for patients to inform their physicians about all medications they are taking, even those that are prescribed by another doctor. She also recommends seeing a physician for an exam annually, so that when a person becomes sick, he or she already has a relationship with a doctor who knows the medical history.

When making appointments, Fox says, patients need to give the staff an idea about why they need to see the doctor. While they shouldn't need to get into too much detail, a longer appointment may need to be scheduled if someone needs to be seen for more than one complaint, she says.

"While we clearly want to address the most important concerns ... what becomes frustrating sometimes is when somebody makes an appointment for an earache," Fox says. At the end of the exam, "they say, 'And by the way, for the past 9 months, I've been tired.' "

Sometimes, people avoid discussing problems -- like those of a sexual nature, for instance -- with their doctors, because of embarrassment. But Arnold suggests patients preface discussions by saying, "This is really hard to talk about, and this is embarrassing."

"Remember, the doctor wants to hear it for professional reasons only, so they can help you with their problem," he says. "I think it's nothing we haven't heard before, and that's what they're there for."

Fox agrees: Doctors have seen and heard it all, so people should put their embarrassment aside.

"I would say it's very likely that your physician has heard this many times; they're used to that, and they're not going to laugh at you," she says.

Gretchen Zimmerman, 59, of Brentwood, praises her orthopedic surgeon -- Dr. Stephen Conti of Allegheny General Hospital -- for the good relationship they have. Dr. Conti did a titanium ankle-joint replacement a few years ago, and Zimmerman says she now is doing very well. She says she feels close to her doctor, who once called her a few days before Christmas to give her the results of her blood test.

"I have such faith in him; he's very easy to talk to," Zimmerman says. "He's just been very good.

"I would say, don't be afraid to ask questions," she says with advice for patients. "That's one of the main things."

How to talk with your doctor , a comprehensive health Web site, offers some suggestions:

• Tell your doctor about any symptoms you are having.

• Share your health history.

• Share personal information about stress and life changes you're experiencing.

• Report any medications you are taking, and any side effects that are occurring, along with vitamins and supplements you are taking.

• Bring any X-rays, test results or medical records you have to the appointment.

• Ask questions every time you don't understand something.

• If you have questions before the appointment, write them down, starting with the most important ones.

• Tell your doctor when you need more time to talk about something. If he or she isn't available, you should be able to talk to a nurse or physician's assistant. If not, see if you can schedule another appointment to continue your talk.

• Take information home with you, like notes, written instructions from your doctor and brochures.

• Follow any instructions your doctor gave you, like taking medicine or scheduling tests.

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