Why is it that, all too often, we come away from a visit to the surgery with more queries than when we went in? It's not all the fault of our traditionally uncommunicative doctors. We've got this mixed-up set of feelings about them: there's the distrust of the medical profession in general, the fear of hearing something deeply unpleasant in particular, and a loss of nerve when face to face with the expert.
No wonder that non-compliance - medical-speak for not doing what the doctor ordered - is estimated to occur in at least one in five patients. A lack of two-way communication and a surfeit of doctor-power are much to blame. If you don't inform your doctor that you can't swallow capsules, or aren't invited to share your worry about the side-effects of a drug, there's a good chance that your pills will gather dust on the shelf. And if you smile and agree with everything, you could be colluding with the doctor in avoidance tactics.
Research shows, hardly surprisingly, that enlightened, assertive patients make more sensible choices and tend to stick to them. They manage chronic illness more effectively and are also better able to handle stress caused by the illness.
Nancy Dye and Robin DiMatteo, psychiatrists from the University of California, have worked out a Theory of Active Patienthood that rests on personal control and a sense of efficacy. The latter means, for instance, that instead of grumbling about feeling weak or frail, older patients with breakable joints make sure there are no slippery floors on which to fall. A patient group encouraged in this kind of efficacy showed a decrease in stress hormones when compared with other groups.
Even children suffering from severe burns who participated in their own dressing changes, whether applying antibiotic or being encouraged to watch the procedures, responded more positively than thoseencouraged to shut their eyes. The latter needed more pain relief and took longer to return to school and resume normal life.
For adults, patients' confidence in the treatment increased with what Dye and DiMatteo call "exit interviews in which a health educator reviewed ... the physician's recommendations and discussed patient-identified barriers to adherence".
Meanwhile, we can play our own part in active patienthood.
Before describing symptoms to the doctor, keep a week's diary of when they occur and what food or drink you've taken.
Prepare in your mind a clear description of your condition.
Write down questions in advance and have pen and paper ready to record replies.
Ask for the names of drugs being suggested, their side-effects and their interaction with other drugs or foods.
Ask about alternatives to drug treatment or surgery.
Share your own knowledge with the doctor and discuss alternative therapies.
If you are not happy with any answers, ask again. Don't be fobbed off.
Ask if there are any medical trials covering your condition.
If you remain in doubt or want more information, ask for a second opinion.
If you have the name of a consultant specialising in your condition, ask if you can see them (your GP may object if the person is outside your district, but under the Patients' Charter you have the right to be referred to your choice of consultant.
Join a relevant self-help group. You learn more about your condition and can share doubts as well as information.
The Patients' Charter lays down your rights: Department of Health, tel 0171-210 4850. The College of Health, tel 0181-983 1225, has addresses of UK self-help groups and information on consultants specialising in different illnesses in your area.
Helen Franks' new book, 'Getting Older Slowly - Your Guide to Successful Ageing' is published by Rosendale Press, pounds 7.99.Reuse content