So you have found a doctor whose personality and attitudes you feel will permit a productive relationship based on mutual respect, confidence, and cooperation. What should you be prepared to expect from each other as this relationship begins?

The Doctor's Responsibilities

You, the patient, are entitled to certain things from your doctor: (1) an accurate diagnosis of your disease and, if possible, identification of factors that make your condition worse; (2) attentiveness to your "story" and honest answers to your questions about symptoms, treatment, and the future; (3) a treatment plan that will permit you to live as normal a life as possible; (4) an education that will teach you both about your disease and the proper use of medications and other therapeutic techniques; (5) adequately close contactmeaning that your doctor is reachable and returns telephone calls within a reasonable amount of timeso that appropriate intervention, when needed, can be done quickly enough to avoid a hospital stay if this is possible; (6) prompt hospitalization when it is needed. If you become a patient in the clinic of a large city hospital, these responsibilitiesexcept for (1), (3), and (6) usually do not apply. Although the clinical aspects of your disease will be competently treated, the reduced staff and funds of the typical city hospital leave their physicians without the time needed to pursue the other aspects, even though they are necessary for optimum treatment.

Because the doctor treating COPD cannot make any substantial impact on the disease when a smoking patient continues this highly destructive habit, the doctor should then assume a strongly supportive role in helping these patients stop. We know that many cigarette smokers can quit, and that their doctor's help and support are tremendously important to their success. Studies show that such encouragement is especially important for smokers trying to quit without involvement in a stop-smoking group.

There are several ways in which doctors can help support their smoking patients' efforts to stop smoking. Some involve motivating these patients. Others require doctors to educate themselves in the techniques found effective by stop-smoking groups. Throughout, doctors must consistently urge their smoking patients to stop. An effective doctor is able to personalize for patients both the risks of smoking and the values of stopping. And it goes without saying that doctors treating COPD patients should be appropriate role models (that is, nonsmokers themselves).

Once smoking COPD patients have made the commitment to give up cigarettes, it becomes very important to express faith in their ability to stay off them. In addition, the doctor should guide these patients in self-control techniques; prepare them for the withdrawal symptoms they may experience; provide educational materials; and refer those patients who need it to an effective group or individual who specializes in helping smokers stop and/or stay stopped.

The Patients Responsibilities

Your doctor is entitled to expect certain things from you.

He needs your honesty in answering all of his questions, as hiding anything (the recreational use of drugs, for example) diminishes his ability to treat you effectively and seriously weakens the relationship's underpinning of mutual trust.

He needs to know that you are committed to getting betterthat you are a full partner in whatever treatment plan is developed. (If you don't follow this treatment regimen, you are wasting both his time and yours.)

You should be gaining insight into your condition. This includes acceptance of your disease as a chronic condition, and an awareness of what improves or worsens your symptoms.

You will call him whenever your symptoms or the effect of your medication changes.

You will not abuse his responsiveness by calling him for inappropriate reasons. You will gradually learn when it isand is notimportant to talk with your doctor.

Remember that doctors are human beings. And all human beings have both good and bad days. So don't be offended when your doctor is occasionally somewhat curt or preoccupied during a visit or telephone call. Give him some understanding when he is having an off day. And do him the justice of bringing up the problem for discussion if it persists.

If you are a smoker, do your utmost to give it up!