THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Wednesday, October 11, 1995 TAG: 9510110506
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Long : 151 lines
When Terence Davies was a young boy growing up in Britain, he lost a beloved aunt to breast cancer.
The boy decided then and there to be a research scientist and find a cure for cancer.
His local family doctor changed that resolution. ``Be a physician first, and be a researcher second,'' he told Davies. ``That's the only way you'll understand what you're researching.''
Davies got thinking about his aunt's terrible bout with the disease, and how a good doctor could have made things so much easier. ``She had received such poor care. She had not been told what the diagnosis was - her husband carried that burden.
``I began to realize that the human process of the person involved was more important than the cancer that caught my attention.''
He framed a question that in one way or another has influenced his whole career: ``How can we find a cure for cancer and simultaneously make having cancer a human process?''
Today, Davies, 60, still applies that question to every patient and every disorder.
His research plans long discarded, he finds his satisfaction on the front lines. Davies is chairman of the department of family and community medicine at Eastern Virginia Medical School. He has recently been named to the new Glenn R. Mitchell Chair of Generalist Medicine, an endowed position that will bring additional prestige to him and money to his department.
But the chair, funded by Sentara Health System, an insurance and hospital management company, represents more than the school's regard for Davies. It symbolizes a change in American health care. Insurance companies and the government, concerned about rising health care costs, are changing coverage to require patients to see their family doctor before getting referred to higher-paid specialists. That means the family doctor is going to be the first doctor a patient sees for almost all illnesses.
That's fine with Davies, who says patients can get better care by forging a good relationship with their family doctors. Although much of his time is spent with teaching and administrative duties, he still sees patients 3 1/2 days a week.
The medical school, he said, has added courses for first-year students to teach them about the doctor-patient relationship, and make them think about how their own biases can affect their relationship with patients.
Davies took some time recently to talk with The Virginian-Pilot. The conversation has been edited for length and clarity.
What would you tell a patient who wants to improve her relationship with her doctor?
The first request I would have of them is: Take responsibility. Speak frankly to the doctor. Tell him what's on your mind. Tell him or her what you think is causing it. If you've got any other matters on your mind, express them - concerns, fears, or expectations. Without that, you're really not giving the doctor a chance. So often people are afraid of making a fool of themselves. Sometimes they just take things for granted and expect the doctor to remember things.
Suppose a patient has a doctor who isn't willing to listen?
Um. . . (He pauses, then laughs.) I guess I'd have to say, ``Find another doctor.''
What can doctors do to listen better?
You put the patient in charge. We may actually ask the patient what they think is wrong.
There's been so much research showing that many, many times the patient leaves the office without having their concerns addressed. Something like 50 percent of the time patients don't even fill the prescription.
Why not? Can't they afford it?
No. Half the time, it's because the doctor didn't find out what the patient was concerned about. So that prescription was for something the doctor thought was important. But he didn't check to find out if the patient agreed.
Insurance companies are pushing doctors to work more efficiently, but it seems like letting the patient do the talking would take longer.
Surprisingly, it doesn't. If patients are given an opportunity right at the beginning to say what's on their minds, it doesn't take long for that to happen. And once there's a clear understanding of why the patient is there, the physician can be quite efficient at finding the information they need (for) a diagnosis.
(Research shows) half the time the physician has not found out why the patient has really come there. In 50 percent of the visits, the patient and the doctor do not agree on the main cause of the presenting problem. The doctor will say, ``I think the diagnosis is arthritis.'' The patient will say, ``I came because I'm concerned about my blood pressure.'' They're as different as that.
In one study, patients were interrupted by physicians so soon after they described their presenting problem - on average within 18 seconds - that they failed to disclose any other significant concerns.
Why do doctors do that?
There is a sense of pressure and a sense of, ``Unless I take charge of this, find out what I think I need to know, I won't have time.'' Basically, that's a fallacy.
What about the arrogance? Doctors have so much more education than most patients. . .
That would be a very unfortunate characteristic for anybody going into family practice. The doctor has a certain expertise, but the patient is the expert in his or her own life story and physical symptoms.
Some patients are difficult to work with. Give me an example from your own practice in which you found a solution for a hard patient.
I think the most difficult are people experiencing a lot of pain. People can be desperate. They demand narcotics and repeated prescriptions.
What I think one can do is develop insight - look for the opportunity where the patient can listen to you and discuss with you in a rational way what is going on. What is this pain?
When we get to that point what I usually do is go back into that patient's history and have them develop with you a picture of their background.
Do you mean you're looking for physical causes, or psychological causes?
You're looking for clues. It may be somatic.
Somatic?
The whole phenomenon of somatization is the bodily expression of internal stresses. There are a wide variety of conditions that fall into that category, ranging from headache to irritable bowel syndrome. Even blood pressure has been described by some as a somatoform disorder.
Does that mean the pain or other problem ``all in your head?''
That's the famous, horrible idea, and nothing could be further from the truth. It's not in your head. It's in your body. That's the whole point. And it isn't a matter of simply referring those people for some kind of psychological counseling. That's why in recent years we've become very (interested) in the potential of biofeedback, and other techniques of that kind.
Has family medicine had something to do with an apparent growing interest in alternative medicine?
That's difficult (to answer) because alternative therapy covers such a huge spectrum of practices. And family medicine is rooted in scientific validation. We have to go by what we can demonstrate is beneficial and not harmful.
On the other hand, (traditional) medicine is opening up, becoming more and more aware that there are things out there demonstrated to be of worth.
Biofeedback, for example, is the treatment of choice for Raynaud's disease, (a condition that causes constriction of blood vessels in the extremities, cutting off the supply of oxygenated blood). It's a very organic condition. People can get gangrene of the fingers. But by utilizing biofeedback, those patients can now be taught to control their condition.
I really believe that 21st century medicine is going to place a lot of emphasis on the mind-body connection.
I think that's the next frontier. ILLUSTRATION: BILL TIERNAN/Staff color photos
Dr. Terence Davies, chairman of the department of family and
community medicine at Eastern Virginia Medical School, was recently
awarded an endowed position for his work in generalist medicine.
Davies explains the medication he is prescribing to his patient
Danny Williams, 68, of Chesapeake during Williams' appointment.
KEYWORDS: PROFILE BIOGRAPHY PHYSICIAN
GENERALIST MEDICINE by CNB