Communication Breakdowns Between Physicians and Patients: a Symptom of a Big Problem with our Healthcare System

I recently found myself in an interesting predicament.

As someone who has long been an advocate for doctors and our healthcare system, I recently found myself in an interesting predicament. I’ve always believed in the expertise of medical professionals, appreciating the challenges they face and defending their efforts in an often-overburdened system. Yet, I completely understand the frustration many people experience when they feel their healthcare needs aren’t being met—or, worse, that they are being ignored. Last month, I had an experience that made me see both sides more clearly, underscoring why many people distrust the system.

It all started with what I assumed would be a routine check-up with my primary care physician (PCP). I wanted to see a dermatologist and had to have an in-person appointment with my PCP to get the referral. As someone with fair skin and lots of freckles, I like to get a yearly skin check to stay on top of any potential issues. This visit, however, quickly took an unexpected turn, illustrating a common yet often overlooked issue in healthcare: poor communication and the anxiety it creates for patients.

Blood pressure and the "silent panic."

Upon arriving at my doctor’s office, the nurse took my blood pressure as usual. The past several times I’d had my blood pressure taken, it had  been high. No surprise—it was high again. I expected this. I monitor my blood pressure regularly and had noticed that it was creeping up, even though I’d been consistent with my diet and exercise. I had managed to lose some COVID weight and had kept up with my training, so I was hoping that would help to stave off the increase. 

Despite my best efforts, though, I knew my blood pressure still wasn’t where it should be. Given my family history—my father passed away from a stroke—and the fact that I don’t sleep well and work several stressful jobs, I wasn’t shocked when my PCP recommended medication.

When my doctor suggested Losartan for blood pressure control, I was ready. “Yep, that sounds right,” I said. But that’s when things got a little strange.

There was an awkward silence as she started typing, andI get it: doctors need to document everything, but for the patient, this can feel weird and isolating. You sit there, waiting for the next step, wondering if they’ve forgotten you. After what felt like an eternity, my doctor suddenly stopped typing, looked up from her screen, and said, “Did you know your liver enzymes are high?”

I did. I’ve had my blood taken several times over the past couple of years for my surgeries and in follow up appointments. So, my initial response was calm. “Yes, my bilirubin has been slightly elevated since my last knee injury and surgery but the other LFTs are normal,” I explained. My bilirubin level, a liver enzyme, had been around 1.4 mg/dL, which was just above normal, but not alarming. Everything else had always come back normal in my previous tests, so I didn’t think much of it. But the concerned look on her face made me pause.

“I’m ordering new labs to check them again,” she said. Then, back to the keyboard for another several minutes of silence and keyboard clacking.

When a simple test becomes a source of anxiety.

I left her office and went to the lab to get my blood drawn. Since this test didn’t require fasting, I could take care of it right away. Twenty-four hours later, the results came back. As expected, nothing had changed. My bilirubin was still slightly elevated, and everything else was normal. No big deal—or so I thought.

That afternoon, I received a message from my doctor: “Your liver enzymes are still quite elevated. I’m ordering additional tests and a liver ultrasound. You can go to the lab whenever you can, and radiology will be in touch.”

Suddenly, I felt like we were going from zero to one hundred. I understood that my doctor had some concerns, and I appreciated her proactive approach to rule out any issues, but this seemed a bit extreme. Was this really necessary for a mildly elevated bilirubin level? Where was the context? The explanation? The reassurance?

So, I wrote her back: “Hi Doc, happy to go get the tests. What additional labs are you ordering, and what are you trying to rule out?” Her response was terse and unexpected: “If you’d like to discuss this further, please schedule a phone or video appointment with me.”

That was it. No explanation, no clarity—just a referral to schedule another appointment. Annoyed, I checked the online scheduler. The next available appointment wasn’t until three weeks later, in September. Meanwhile, I was left in limbo, now slightly panicked that I might have liver disease.

The downside of being "health literate."

In reality, I was fairly confident that nothing serious was happening. Based on my research and knowledge, I believed the elevated bilirubin was likely a result of my previous injury and ongoing heavy training. Still, I planned to get the tests done. Even with my health literacy, though, I couldn’t shake the uneasy feeling that something might be wrong. I could only imagine how someone with less understanding of the medical field might feel in this situation. 

I waited a few days and then wrote to my doctor again, explaining that I couldn’t get an appointment for another three weeks and was concerned about the lack of information. And then … nothing. No response. 

It had now been almost a week since her initial email, and I was feeling frustrated. She had ordered "additional labs and a liver ultrasound," but provided zero explanation as to why. When I asked for clarification, I was met with silence. 

The bigger problem: a system that doesn't communicate.

At this point, I wasn’t angry about the diagnostic tests themselves—I wanted to rule out any potential issues, too. But here’s the thing: I have enough knowledge to understand what’s going on with my body and interpret medical tests. I can manage my own anxiety because I know how to put things in context. What about the millions of people who don’t have that background?

This is where the system breaks down. My doctor had just prescribed me blood pressure medication to lower my body’s response to stress, yet her lack of communication was causing more stress. If I weren’t well-versed in biology, I’d likely be in a full-blown panic by now, with no guidance from my care team.

It’s no wonder so many people turn to alternative or complementary solutions. Faced with a healthcare system that doesn’t communicate effectively, patients often seek out options where they feel heard and empowered. Whether it’s paying extra for a concierge doctor they can reach by text or trying supplements that may have little scientific backing, people want to feel like they have control over their health. Even I, someone who knows better, found myself thinking about ordering some milk thistle.

Where do we go from here?

My experience is just one example of the communication breakdowns that erode trust in healthcare. The system is flawed—not because doctors lack knowledge or aren’t trying, but because they don’t always have the time or infrastructure to truly connect with their patients. When patients are left in the dark, they turn elsewhere for answers, often to less reliable sources.

So, what’s the solution? We need a healthcare system that values communication as much as diagnostics. Patients should feel informed and empowered, not anxious and abandoned. While I don’t have all the answers, it’s clear this system isn’t working for most people.

After completing the liver ultrasound and a comprehensive battery of liver function tests, everything came back normal. While I was relieved by the results, this experience highlighted a broader issue within traditional healthcare—its largely reactive nature. This approach often waits for problems to manifest before taking action, causing unnecessary stress for patients.

I wrote about this recently in a manuscript with a physician colleague on a new paradigm we are calling “Performance Medicine.” Our vision is that taking a performance medicine approach emphasizes a proactive stance, which focuses on optimizing health and preventing issues before they arise. In this way, Performance Medicine can bridge this gap by providing individualized care based on early detection and a thorough understanding of one’s physical condition. By integrating regular check-ups, advanced diagnostics, and tailored interventions, we can move from treating symptoms after they occur to fostering long-term wellness and performance. This is unlike concierge medicine, or popular alternatives such as “functional medicine”. For what it’s worth, “functional medicine” isn’t really a medical specialty, but a very expensive certification and often relies on supplements vs. pharmacology. Performance Medicine, rather, is about using a proactive medical and lifestyle based approach, rather than simply being reactive. 

I’ll continue to go to my primary care doctor because I believe we have the best medical system in the world—and I truly do appreciate her ruling out any potential issue with my liver. Honestly, I’m very grateful for her due diligence. But there’s no denying we still have a long way to go before it’s a perfect solution to people’s ever-evolving healthcare needs, and communication needs to be paramount.