The keys to building better doctor-patient relationships are sharing information and responsibilities, and finding providers with the right ‘fit,’ according to researchers, who said people with fibromyalgia repeatedly experience difficulties in their clinical care interactions.
These were the findings of a study, “Factors in the Building of Effective Patient–Provider Relationships in the Context of Fibromyalgia,” published in the journal Pain Medicine.
People with fibromyalgia often report a lack of understanding from medical and healthcare staff, which translates into frustration. Similar challenges are reported by patients with chronic pain, often labeled as hypochondriacs and not taken seriously.
To find ways to improve clinical interactions, the researchers examined which factors — from the patients’ perspectives — play an important role in building an effective relationship with physicians.
They analyzed data from 23 fibromyalgia patients enrolled in a prior study, assessing the link between health management and information behavior over time. Participants were interviewed about their health history, information seeking and use, and social media participation. The mean total interview time was 2 hours and 26 minutes per patient. The researchers used interview transcripts for their analysis.
Most participants were white women (22), with a varied range of age (from 21 to 79) and illness duration (from one year to 58 years). The majority (20) had the disease for more than four years.
The patients visited a range of doctors, including general practitioners, rheumatologists, and neurologists, as well as alternative medical practitioners, including chiropractors, acupuncturists, massage therapists, physical therapists, and naturopaths.
Three key factors found in the interview analysis to underlie a successful relationship between patient and practitioners were: sharing of information, identifying healthcare providers that fit patients’ needs, and sharing the responsibility for becoming care “partners.”
One of the most common complaints from participants was the lack of information they obtained from practitioners. Indeed, some reported withholding their fibromyalgia diagnosis from providers to obtain clearer medical explanations. They also reported being prescribed certain treatments with no explanation why.
Women in this small study, however, also reported cases in which providers referred them to additional fibromyalgia resources, like research studies, or shared information that could help them better manage their condition. Some also reported collaborative information sharing, in which physicians were open to information that patients brought to their consultation. Engaging in shared problem-solving helped establish more successful patient-clinical interactions, participants said.
Another important factor in relationship building, the researchers said, is the need for patients to better recognize what they need from providers, and which practitioners they can work with the best. This means finding a practitioner that takes the time and effort to listen, is open-minded, and engaged in sharing of information, the study said.
“This process could perhaps be facilitated through the development of patient education materials that assist patients to identify characteristics that they consider important in selecting a provider, to help them communicate with providers, and to set realistic expectations,” the researchers said.
People with fibromyalgia “are not looking for providers to be ‘perfect,’ but ‘partners.’ Additionally, they may also shift from expecting physicians to ‘solve their problems’ to an expectation of a shared responsibility,” they said.
Noting that many people with fibromyalgia do a good deal of research on their own, the investigators said clinicians should do more to improve doctor-patient information exchange.
“We can provide tools for patients to organize the information that they gather from different information sources and communicate questions to providers,” they said, adding that physicians would benefit from materials outlining what information fibromyalgia patients want to know.
Though it may seem that discussions like these might take more time, the study results showed patients’ “cognizance and consideration for the limited time that providers have.” Researchers said agenda setting could lead to more concise and effective consultations.
“[P]atients and providers both need to contribute in order for clinical relationships to be successful,” the researchers said.
“For patients, providing information about selecting and working with providers and how to make the most of clinical consultations can improve productivity. For providers, learning more about patients’ expectations can help them to provide better care,” the study concluded.
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