The Relationship Between Doctors and Patients

This article is not about doctors or patients; it's about all of us.

Eyes of Patients

In the clinical setting, some doctors use their autonomy to view only what they want to hear and not look at the patients directly. This is not only disrespectful but upsetting to the patients, who would only want to tell the doctors why they are there. If the doctors could just stop jotting and scribbling esoteric medical acronyms in their clipboard and turn to listen to them, everything would be so much better.

It's true that some of discontents from patients come from high cost of medical care and egregious doctors who are just "bad doctors" and cannot deliver proper care. In more common cases though, many of unpleasant feelings from doctors come in the form of not listening carefully or treating patients as subjects containing diseases rather than living human beings.

For instance, a poor communication will lead a doctor to say, "Stop working until your hands are better," without providing exactly how someone would be able to continue to be the breadwinner of the family in that time period. Furthermore, if this patient returns two weeks later after working (since he had no other choice and could not risk unemployment for his family), the doctor who didn't listen to his patient's story will immediately reprimand the patient for not following his order. While we cannot say the patient did the right thing by worsening his condition, can we say that the doctor is exonerated from any blame? I think not - if the doctor listened, he/she should have come up with another plan to improve his condition while reducing the burden on his hands in the workplace.

Last spring, I went to a talk by a director of physician assistant (PA) program. This director argued that PAs can do what some doctors cannot - really listening to the patients. He explained that because PAs have shorter training in their program (about 2 years outside the 4-year college/university work) and dedicate nearly all of their time to direct patient care and cases for common diseases, they are still close enough to the patients that they can know what it feels like to be patients and deliver the necessary care simultaneously.

While I disagreed with him on the idea of assigning too much autonomy to PAs without necessary supervisions under doctors, I do concur on the importance for doctors to listen to the patients of their symptoms, background, and other relevant details. My hope is that since more and more medical schools are putting large emphasis in patient communication, this problem will be solved in the near future.

Eyes of Doctors

Due to the constantly changing legislation regarding health care and the rising costs of prescriptions and insurance costs, doctors are in a limbo. They realize that to a certain extent, medical care has become flooded by various tests and exams that sometimes serve the purpose of preventing malpractice lawsuits for doctors more than fixing the patients' problems. At the same time, some remain hesitant to order exams because they see that not every patient can offer those treatments, and not every insurance company will be willing to cover it.

In addition, I think that the one of the most challenging thing about doctors is that sometimes, doctors have hard time imagining what it was to be a patient. In one article from Time magazine, Dr. Pamela Gallin, director of pediatric ophthalmology at New York Presbyterian-Columbia Medical Center, said, "Doctors are terrible patients because they know too much. They can't be both doctor and patient at the same time."¹

It would be incorrect, however, to solely blame doctors for not seeing the patients properly because they can't feel as the patients again. In some cases, patients refuse to follow doctors' orders even when the circumstances allow them. For instance, let's say that a doctor asks a patient to cut down on his late night munching of potato chips or change to baked potato chips, which are slightly a bit healthier. Cutting down snacks will not be easy, but it is not difficult enough that it puts heavy economic burden on the patients.

Now, imagine seeing stubborn patients like this one every day. Eventually, the frustration will overcome the doctors and prevents him/her from trying to persuade such patients anymore. I think that in reality, while every doctor tries to be concerned and inquisitive in the early part of their career, meeting stubborn patients who refuse to talk (or listen to what the doctors have to say) will steer some away from proper communication.

The Last Remark

The relationship between patients and doctors is a very complex matter, and I certainly see that my article does not address every case. In some cases, I understand that the patients cannot change doctors despite their bad behaviors because 1) they still fix the symptoms, and 2) alternate options are not feasible either by distance or lack of insurance coverage. Also, I can see from doctors' point of view that some patients, no matter how hard or long you try to persuade them, will not do what you ask them to do.

The only thing I can advise for both sides is to listen and view the situation from the other side. This is easier said than done, so actually committing to do so takes efforts and energy. But, without really trying to understand each other, the medical care won't be able to deliver its full potential no matter how good the medicine is. Remember, communication is like clapping - it requires both sides in order to work.

Works Cited

¹ "Q: What Scares Doctors? A: Being the Patient," Time 23 Apr. 2006; can be accessed online by:
http://www.time.com/time/magazine/article/0,9171,1186553-2,00.html