In this episode, Dr. Gil explores what makes a good doctor patient relationship. We explore how the importance of trust, and how each person is an expert in the room. Finally, Dr. Gil discusses SEAMMS, a handy short-hand to understand your symptoms and your body.
The doctor patient relationship Transcript
Doctor Patient Relationship Full Episode (New Transcription)
On a previous addition of Ask Dr. Gil, I pose the question what makes a good doctor. I want to rephrase the question and ask it slightly differently, which is what makes a good doctor patient relationship or doctor client relationship.
On today’s episode of Ask Dr. Gil, I want to explore some of the issues that help the relationship aspects of healing. So stay tuned.
Hello, and welcome to Ask Dr. Gil. I’m Dr. Gil Winkleman. And on today’s podcast, I want to explore some of the issues related to healing as it relates to relationship of the clinician and the patient. And I want to start by sort of discussing the whole doctor patient paradigm, because in some ways, there are power dynamics involved with this that may interfere with the ability for someone to get better. How do we approach this? Because there’s two experts in the room when we’re dealing with a doctor patient relationship in a sense.
The doctor is the expert ideally on medical knowledge, physiology, and if they’re holistic diet, vitamins, etcetera, herbal, herbal remedies and so forth. The patient is the expert on themselves, hopefully. And that’s the dynamic. Right? I mean, I have hundreds, thousands of patients over the course of twenty plus years of practice, and I understand the body in a general sense.
I can identify things. I understand if you’re having x, y, or z symptoms, it may be coming from one of a few places. But I don’t understand necessarily the person specifically. And that requires time because I don’t know, you know, someone after one or two visits, it takes a while. And from my own self, personally, So part of where this comes from, this this talk is is I have my own physician, Dr. Thom.
There’s some videos of him on my YouTube channel in case you’re curious about him. And they’re very old and and very early 2000s. But, you know, what’s interesting about my relationship with him is that I’ve been working with him for over twenty years. He’s been a mentor to me and my personal physican. He’s seen me go through lots of things in my lives, you know, my life. He’s seen me go through medical school. He’s seen me start up practice, he seen me have my children and move and all this other stuff that I’ve done.
And he knows me when I say I feel really stressed, he knows that’s serious because generally I’m not particularly stressed. I’m pretty calm, easy going person. So it’s it’s an interesting aspect, which if he didn’t know me that well, he wouldn’t, when I say something, he wouldn’t necessarily know how to interpret that. And, you know, the thing about this is, is that patients tell us things in the you know, in the intake. And and we understand certain aspects of that.
Right? But there are gaps in that. Right? There’s gaps. First of all, they can’t tell us everything in the first visit.
That’s first off. And that’s just a function of time. Right? You know, I mean, there’s aspects of things that there’s a focus. We’re focusing on certain things.
But what’s interesting to me is sometimes there are things that are not said, at least at the beginning, that are actually very pertinent to the case, but then come out later. Patients who have trauma, you know, I’ve had patients who I’ve worked with for a long time. And I have this by the way in my intake forums, but not everyone shares that. And I think some of that has to do with trust.
Right? It’s like they don’t know me either, so they don’t know what they can reveal or not reveal. So some of that requires time. For both sides. It requires time for them to say, to feel comfortable with me and say, yeah, I can share this with Dr.
Gil, or whichever doctor. And I think that that aspect of things is is also really important in terms of of a time function. The other interesting thing, and and I don’t really have an answer to this. And we’ll talk a little bit more in the second half of the program about themes which are important for understanding the body’s health in a general sense. But oftentimes, patients don’t know what is pertinent.
And by the way, that’s sometimes true for the doctor as well. But, you know, for example, I have patients who have environmental illness or environmentally based illness and don’t understand the fact that they work in an industry where they’re breathing in a lot of heavy metals, for example, is causing their illness. And so knowing that and you could say, yeah, it’s up to the doctor to ask that question. I I don’t disagree with that, but and and I’m using this as a a pretty obvious example. But there are subtle ones that show up where a patient will say something to me over time and I’ll be like, wait a minute.
Maybe these symptoms are coming from that. And it’s never easy to figure that out. So now the other piece about the doctor patient relationship that’s interesting is that sometimes patients say things that doctors don’t want to hear, like they’re not feeling better after they took x, y, or z. And and doctors say things that patients don’t wanna hear, like, you need to eat less sugar or the inflammation in your body is being caused by your diet, or you need to go to bed earlier, whatever it is, you know. And these are the things that are really interesting.
And in terms of how do people navigate that relationship? So, now, there’s really no easy answer to this. This is also another aspect of where the trust comes in because as I get to know patients better, I trust that they’re going to share the pertinent information with me. And as they get to know me better, they trust that what I’m telling them is going to help them feel better. And the challenges is sometimes this doesn’t happen right away.
You know, because because if you think about it, to get into if you have a chronic illness, to get into that state, it took more than a year for that to happen. So it’s gonna take time for it to unwind. And that’s kind of the piece to this that’s important. So we’re gonna take a quick break and in the second half of the show, what I want to really discuss is the seams. Which is a system of sort of evaluating patients.
And I think it’s important I share this with you because this is something that you can use to help yourself communicate with your physician. So stay tuned. Hello, and welcome back to Ask doctor Gil. I’m doctor Gil Winkleman. And today, we’re talking about therapeutic relationships.
And what makes a good doctor and what makes a good patient. So if you have any questions, please feel free to email me at infoasdrgill dot com, that’s I n f oas k d r g I l dot com. You can also put comments in the section if you happen to be watching this either on my website or YouTube or somewhere that takes comments. So there’s a number of factors here that we sort of have touched on, but we’d like to cover in more detail. And the first is looking at symptoms because it’s very important to understand what is going on in your body that you can then let your doctor know, which will then be useful to help figure out what’s going on.
And if there’s one thing you get out of the good doctor aspect is, in my opinion, thinking holistically. And I think one of the issues in medicine today is that we don’t have gatekeepers who are thinking in the broad scope. They’re really the problem big problem in the United States at least is we have very much overworked primary care providers that are trying to get through as many patients as possible in a short amount of time that they have. And it’s difficult to get in to see them. And I’ve had a number of patients who have expressed frustration in terms of finding a good primary care doctor to order tests or refer them to a specialist or something to that effect.
And they’re just not enough of them. A, and B, the ones that we have don’t have the time to really delve into the big picture of what’s going on with the patient. And it’s very much a very surface sort of approach. And there and I’ll do a podcast about nutrition in the coming weeks, but one of the things that’s very clear is a lot of health problems start with a bad diet. And this is something that isn’t addressed in the primary care realm.
So that’s kind of piece of it. And I’m going to talk about symptoms a minute, but before I say that, it’s part of the issue that I’ve seen in healthcare is that patients don’t necessarily trust their physicians. And part of that is that mainstream medicine has been falling down, I would say, in many ways. And those are the people that come see me So there’s that. But also, I think trust needs to be earned and it takes time.
And this goes back to the relationship aspect of things in terms of what makes a good therapeutic relationship, and I do think trust is a big part of that. And Sometimes, trust is earned quickly and sometimes it just takes time. And, you know, one of the things that I do appreciate about the holistic approach to treatment is most of the time, not all the time, but most of the time the side effects are lower as well as less long term. And I talked a little bit about this in my neurofeedback podcast, I think, but you know, when when you treat someone using neurofeedback for example, that and you hit the wrong point as it were, the problem lasts for a day or two and then it goes away. And it’s not permanent.
And I’ve been working with people lately who have had very severe issues with pharmaceutical agents from Cipro that’s a big one. I may do a podcast about that as well because that’s an interesting one where it’s called getting flocks and there’s a couple of books out about this and what to do about it. But it’s basically an overwhelming of the inflammatory systems in the body. But also, psychotropic drugs such as well butrin and Prozac’s lexipro people of having bad reaction to those medications. And those are more long lasting.
And so that can lead to a mistrust. And it’s not necessarily the doctors fault per se. This is just the model that they’re in. So So that’s kind of piece of it. Now, here’s the thing that I’m going to tell you that can help you get healthier, faster, or at least have a better relationship with your doctor.
And that is to be able to understand your own symptoms. And so what I do is look at it from this place, I call it, the seams, sleep, energy appetite, which includes digestion, mencies if you’re a woman, musculoskeletal issues and sense of well-being. So those are, it’s s e a m m s. And knowing what your score is in all of those, will give us a determination of your overall health. Now the add on to that would be for extra credit is if you have a continuous glucose or labs can add on to that.
But labs are only part of the picture and the continuous glucose monitors are an issue because they’re not always accurate. I actually had a conversation with a patient about this recently and she said she’s been taking her she uses a GCM, and she takes her insulin tests anyway because it’s often wrong, the GCM. So, you know, and I bring up glucose because that’s related to both appetite and energy. And if your energy drops suddenly, that could be because your blood sugar isn’t being controlled and regulated properly. I mean, there are other factors with that.
But understanding your energy Do you have crashes at certain times of the day? Do you need to eat constantly those sorts of things? Sleep? Are you getting enough, you know, seven to nine hours a night? If you’re an adult, your appetite is do you have a good appetite?
Do you have good digestion? Are you having regular bowel movements? You know, Menses? Are they are you Menses are regular heavy flow, light flow? Do they alternate?
Do you have periods intermittent spotting? Those are sorts of the sorts of things that are important. Musculoskeletal. Do you just pop out of bed? Or do you have aches and pain?
Are you stiff in the morning? Do you find that if you just lift your arm or do something funny, your your backs out for a week? Those sorts of, you know, that sort of thing. And then sense of well-being is a really interesting one because that’s one that I definitely think most doctors do not ask about. And I’ve had patients who kind of like their seams were fine and then but they they kind of have this funny feeling in there.
Oh, and mood, that’s the other one. There’s two m’s in there. So mood is the other one. And But but mood and sense of well-being are not necessarily the same thing, but they’re kind of related. So mood is your emotional state.
Sense of well-being is sort of your spiritual state. And just feeling like you’re on the right path in life, that sort of thing. So people, you know, sometimes when your mood drops, or if you’re depressed, that can be a sign of inflammation. And these are the things that are important to talk about with your physician. And of course, this is why the relationship is so important.
And sometimes it seems like when there’s clinical relationship like this, it can look like two people just talking. Right? It doesn’t If I could tell you about conversations that I have witnessed between doctors and patients, over the years in my observational studies when I was in medical school and stuff, they they often aren’t necessarily around physical symptoms. And what was interesting about this is that, you know, clearly, there is rapport there and and a sense of of camaraderie, and I talked a little bit about this I’ll talk about this now is that it’s not necessarily that we want to be the expert as a physician because it’s just two people hanging out. And the person who is the on the physician role, I’ll just say it that way, will observe certain things and be able to sort of make inferences from that, and then kind of help the patient move forward in whatever way that is necessary.
So this is an intangible aspect of the healing relationship. And it’s, you know, it’s like talking to a friend about a situation that’s going on and then feeling better. And it but it’s not necessarily about the content. It’s about the connection. And this is the other piece that I think is underrated in healthcare.
Because and we’re the rushed visits trying to get through in a six minute, I think that’s the average still. Six minute session with the patient patients who feel hurt, and I’m guessing that’s part of what’s been going on here in for many people who have been coming to me. And the problem is that there’s not enough doctors doing this. Right? And the other thing in terms of the therapeutic relationship, I will say, is that sometimes healing takes time.
And it’s not like the symptoms that you have if you have a chronic illness showed up overnight in most cases. It has been something that has been building over time. And so the solution is also not going to happen overnight in most cases. Not that it doesn’t happen. Spontaneous healing does happen, but it’s not common.
And and so understanding that and understanding that this is a journey will also make the therapeutic relationship go better because then there’s less pressure on the physician to find the answer, fix it, and determine what’s going on right away. Because that’s a lot of pressure to put on somebody. Right? I mean, certainly, there is a path and most holistic doctors that I talk to will understand what the path is if they’re intelligent and good doctor. But they also understand that it’s not going to happen overnight.
And I think the role, the person in the patient role is important for them to understand that. And sometimes the doctor doesn’t communicate that very well. That’s the and this is the challenge. This is always the challenge. And communication is always an issue in healthcare because usually when the person is coming to a physician there is a level of stress and their ability to hear what the doctors saying to them sometimes is for lack of better way of saying this impaired, because there’s a stress level involved with this.
Right? I mean, it’s not easy to tell someone else about what is going on with you. Sometimes it’s embarrassing, sometimes it’s uncomfortable. Some sometimes you’re scared because you’re worried that it’s something serious. So that’s part of the issue and the challenge with with this.
So Alright. So hopefully you enjoyed that. If you have any questions or comments, please feel free to leave it on the podcast page or YouTube depending on how you’re viewing this. I also if you have questions, feel free to send me an email at info at doctor Gil dot com or check out my website, askdrgil.com. And I look forward to seeing you in the next episode.
Thanks so much and have a great rest of your day.
