Decades ago, the relationship between a patient and a doctor was often asymmetrical. The doctor decided what treatment was needed and issued “doctor’s orders.” Patients were expected to follow through, no questions. In most cases, they couldn’t ask questions because they didn’t have access to enough information to formulate reasonable queries. How 20th century!

Today, patients have far more information available to them, and they expect to participate in making decisions about their health and their treatment. When the doctor is enthusiastic about shared decision-making, the relationship should go smoothly. But if either the doctor or the patient expects a different type of relationship, there may be problems. How can you resolve them?

Sometimes, a patient may discover that she doesn’t like the treatments her doctor has recommended. If a discussion of the options doesn’t yield a more acceptable treatment she feels she can follow, she may need to seek a different doctor. What is the best way to do this? How do you make sure that your medical records make the change as well? Do you as a patient have a right to fire your doctor?

Occasionally, a doctor will tell a patient that unless he follows through on the medical recommendations, he will no longer be welcome as a patient. Does a doctor have a right to do this? When is this action justified?

A doctor-patient relationship is two-sided. Patients who skip appointments or fail to pay their bills can expect consequences from that behavior. Likewise, doctors who appear uninterested in a patient’s health concerns may also anticipate that the patient could react. We get perspectives from both sides of the stethoscope.

JAMA has just published a viewpoint on Trust in Health Care that is relevant to the relationship between patients and healthcare providers (Jan. 24, 2019).

Trisha Torrey founded Every Patient’s Advocate. After a frightening misdiagnosis in 2004, she decided that we all need to learn to take better responsibility for our own medical care. Since no one teaches us to be smart patients, she started on her journey to change that.

Since then she has written 6 books, including her You Bet Your Life books, and has worked toward development of an entirely new profession – that of independent, professional healthcare advocate.

David Meyers, MD, is the Chief Medical Officer (CMO) of the Agency for Healthcare Research and Quality, where he assists in strategic planning. He also leads AHRQ’s response to the nation’s opioid crisis and directs EvidenceNOW, AHRQ’s $110 million initiative to help primary care practices improve the heart health of their patients through quality improvement support and the implementation of new evidence.

Prior to his appointment as CMO, he directed AHRQ’s Center for Evidence and Practice Improvement. He also has led the Agency’s primary care Practice-Based Research Network initiatives and served as the Acting Scientific Director for the U.S. Preventive Services Task Force.

Before joining AHRQ in 2004, he practiced family medicine, including maternity care, in a community health center in southeast Washington, D.C., and directed the Georgetown University Department of Family Medicine’s practice-based research network, CAPRICORN. He is a graduate of the University of Pennsylvania School of Medicine and completed his family medicine residency at Providence Hospital/Georgetown University. After residency, he completed fellowship training in primary care health policy and research in the Department of Family Medicine at Georgetown University.

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