The relationship a physician has not only with their patients, but also with their patient’s families, has long been the foundation of the medical system. Over the course of time this once valued bond has had its ups and downs; however today with the internet, Obama healthcare reform, and Medicare cuts to name a few, the doctor-patient relationship finds itself in its most fragile state. This past week I was exposed to both extremes of this delicate relationship, and realized there is still much to be learned by both physicians, patients, and their families alike in order to keep this foundation from collapsing.
Physicians, contrary to popular belief, are humans. We are not Gods, heroes, or miracle workers. We are ordinary humans who through knowledge, training, and experience have developed an understanding of the intricacies of the human body, its function in health, and its dysfunction in disease. We have dedicated most of our lives to this process, at the expense of our own family and friends, mainly because we love helping others and care about our patients (most of us anyway). Though at times capable of some amazing things, in the end we are all just human—imperfect, and prone to make the occasional mistake.
Just as each patient has their own unique personality, each physician also has their own unique personality. Therefore it’s virtually impossible to make any generalized assertions as to what personal qualities of a physician are likely to make each individual patient feel at ease. There are some who prize their doctor’s compassionate, friendly manner; others who are more comfortable with a more formal, professional stance. Some like an authoritative, take-charge manner, while others prefer more of an equal relationship, where their participation in decision-making is freely elicited, and reciprocity ensues.
There are some characteristics, however, that are universally appreciated and should be displayed by all physicians: spending enough thorough time with the patient; sharing, without restraint, your reasoning process and expertise on treatment decisions; being open to questions, no matter how technical on the one hand, or uninformed on the other; treating family members with consideration; and being available in a reasonable time frame both during and outside of office hours.
The trust between the doctor and the patient needs to be rebuilt. News reports about medical errors and drug industry influence have increased patients’ distrust. Drug advertising targeted directly to the consumer along with medical web sites have taught patients to research their own medical issues, making them more skeptical and inquisitive of their physicians. Current medical science and technology have given physicians new tools to treat diseases and to keep patients alive for longer periods of time than would be possible in the past. However, there are times in the management of the patient’s illness when the physician finds that further energetic diagnostic tests or treatment to attempt to treat the disease or try to prolong life would be futile. A treatment might not be expected to work or an expected outcome would be unlikely, particularly if the resultant quality of life would be considered poor. The treatment might, instead of prolonging life, only prolong a difficult dying. But there is still controversy amongst physicians and amongst patients along with their families as to what futile means and when a procedure or treatment can be called futile. Physicians may find one treatment approach futile but the patient or family member may disagree and deny futility. Occasionally the opposite occurs with the physician resisting discontinuing a treatment. What is needed is some consensus between physicians and the public as to what establishes a determination of futility. A patient’s family needs to trust that the physician has the patient’s best interest in mind. The physician needs to realize when enough is enough, and that he/she is not a hero.
There are many complexities that have made the doctor-patient relationship what it is today, but one thing is for certain: you can’t effectively help someone you can’t get along with.