Imagine this scenario: You walk into your doctor’s office. The administrator behind the sliding glass greets you by name. Within a few minutes you’re admitted to the inner sanctum. Your doctor enters, shakes your hand with a sincere smile, and asks about your garden or your classic Mustang -- something that shows you are remembered. Your time with the doctor lasts a full half-hour, and never feels rushed. You leave feeling as if your doctor has heard you. You feel informed of your risks. If you need tests, you understand their purpose. And you know that your doctor is going to keep working on your behalf, after you leave the office.

For some, that scenario is a reality. Others, however, would consider this doctor-patient relationship out of reach. It isn’t uncommon to encounter at least a few of the following problems when visiting the doctor:

• Front-office personnel who ask you to fill out the same paperwork you filled out last time.
• Long waits in the waiting room, followed by long waits in cold exam rooms on a paper sheet reading bad magazines.
• An overworked doctor who gives you a token smile and hunches over your record, trying to figure out just what your deal is. You are well aware that you’re just one of hundreds of patients. The doc barely remembers you.
• A visit that seems too brief.
• Advice and maybe a prescription that seem to fit a type of problem, not necessarily your individual problem.

How can you tell when your relationship with your doctor is truly lacking? Before you can be sure, it’s worth looking at things from the doctor’s point of view, and putting these scenarios in the context of the whole modern, impersonal health care system. You may be surprised to find out that having a good relationship with a patient is just as important to your doctor.

In the doctor’s shoes

Most doctors want to give you the best healthcare possible. And most of them are just as frustrated by the squeeze today’s health care business puts on the traditional doctor-patient relationship.

They increasingly earn less for their work, as insurance companies and Medicare lower reimbursements for the care they provide. In turn, they need to see more patients to keep their practice viable. Their patients may not communicate enough vital information, or may be overly chatty, or too worried, or not worried enough, and, in recent years, armed with their own online research from whatever health website they stumbled across.

All of these factors can add up to a less-than-ideal relationship. As a result, experts in health care have been focusing on the communication barriers between patients and doctors.

Richard Frankel, PhD, professor of medicine at the Indiana University School of Medicine and senior scientist at the Roudebush VA Medical Center, specializes in the study of doctor-patient relationships. He and his colleagues have found that effective communication can make tangible differences in a patient’s health, including lower blood pressure, less frequent migraine headaches, and lower blood sugar readings in people with diabetes.

Frankel suggests that doctors and patients could communicate much more effectively if they followed the lead of pilots and air traffic controllers, where each player systematically confirms the transmissions of the other.

"In the year 2000, the Institute of Medicine published a report that said patient-centered care -- a partnership between provider and patient -- was a marker of quality. The majority of errors are in communication."

In recent years, many health care providers have focused on improving communication, often with simple practices like asking patients to repeat what they’ve heard to verify their understanding. Follow-up studies have shown these simple techniques yield large benefits.

Patient-centered care represents a fundamentally new approach within our current system, and the doctor-patient partnership spreads responsibility both ways. If you want to play a full-fledged role in your own health care, there are several things you can do to help your doctor:

• Keep a list of your medications and any supplements you might be taking. Bring that list when you visit your doctor. In fact, keep it with you at all times.
• Make another list of things you want to discuss, in order of importance. After you’ve talked about them, ask your doctor to include those questions in your permanent medical record.
• Bring a notebook and take your own notes during the meeting. Make sure you understand what’s been discussed.
• Ask your doctor to explain anything you feel vague about, including the results of any recent tests you’ve had.

If you arrive at your appointment prepared, have your thoughts in order, ask sensible questions, and keep to the point; you’re not only likely to give your quality of care a boost right then and there, but your doctor will most likely remember you as someone who has made their job easier. That bodes well for your future health care.

Irreconcilable differences

It’s important to remember that a good relationship with your doctor doesn’t necessarily mean constant warmth and friendliness. Many patients simply prefer to put their confidence in their doctors the way they would with car mechanics or airline pilots. They feel they’re paying for expert service, they expect it to be competent, and they’ll do their own part to follow orders. Period.

Still, there are times when these relationships are just too frustrating, too uncomfortable, and, most importantly, not conducive to your good health. Here are some telltale signs that it may be time to shop for a new doctor:

• Your doctor seems to resent being asked questions, won’t answer them to your satisfaction, or tells you just to follow directions.
• Your doctor often seems rushed, distracted, and not strongly focused on your visit. This includes regularly taking phone calls or questions from nurses or staff members during your appointment.
• Your doctor seems to have to go back to square one every time you visit. You get the feeling that when the doctor opens your file, there’s no continuity, no memory of you or your state of health the last time you visited.
• You lack confidence in the doctor’s staff, who often seem hurried, rude, and unprofessional, and who get details wrong often enough to be worrisome.
• Your doctor’s office is so far away, or simply so inconvenient to reach, that you dread going there, and will avoid possibly important visits just to spare yourself the hassle.
• Your doctor simply gives you "bad vibes," to the extent that you don’t want to visit, and feel frustrated or upset after a visit. You may have doubts that your doctor is competent, or cares much about you, or you may not be able to put your finger on the exact cause of the feeling. But it’s persistent.

If you do decide to change doctors, there are several ways to research new ones. One of the most effective is simply word-of-mouth. Ask your friends for recommendations. Talk to people in the health care business in your town: Nurses, therapists, physicians’ assistants, and lab technicians usually know which doctors are both competent and caring, and which ones to avoid. Internet research can help fill in details about a doctor’s training, credentials, and experience.

If you’re a member of a health plan with restrictions, you’ll need to make sure that a prospective doctor is in your network. Then call the doctor’s office for an interview appointment. If you can’t schedule a visit for weeks, or get the run-around from the front-desk staff, that’s not a good sign of things to come.

You will need to transfer your medical records to your new doctor. In the United States, only you and your health care providers have the right of access to those records. You can give permission for your new doctor to have access to your records under the Health Insurance Portability and Accountability Act (HIPAA). You will need to make that request in writing, and may have to pay a fee. The transfer can be arranged between the two doctors’ offices.

The bottom line

Before giving your doctor the boot, try to bridge the communication gap. Look at the visit from your doctor’s point of view. And feel free to mention that you haven’t had all your questions answered. Your doctor may be surprised, receptive, apologetic, and willing to make a strong effort to bridge the gap. If not, you’ll have further confirmation that leaving is the right thing to do.

Doug Logan is a freelance writer from Branford, Connecticut. He last wrote in Synergy about "Scary Health Warnings" and "Celebrity Addictions." Reach Doug at featuredstories@adamcorp.com.