Top Posts: April 2014

Twenty-five posts that struck a chord this spring. Main Image: Shutterstock

Act Like a Doctor, Think Like a Patient

Can patient-focused medicine be taught?

If your doctor is so smart, why can’t he think like a patient? 

Medical education prepares today’s doctors to do amazing things, but thinking like their patients is not one of them. Taking care of people for 35 years has shown me that thinking like a patient is enlightening and helpful—to both patient and doctor. 

I happen to practice dermatology, but these observations have nothing to do with skin. Every clinician takes care of patients, and every patient has thoughts and opinions about what is wrong and what to do about it. The question is whether the doctor knows or cares about these thoughts and opinions. Often, the doctor does not. And that’s a problem.

The body is a marvelous mechanism, but when a mechanic fixes a machine, the machine does not have to agree with the repair manual. By contrast, the human machine comes equipped with a mind. A doctor who doesn’t know the ideas in that mind may do a poor job of healing. Even more important, he may fail at what seems to me a doctor’s central task: to make the patient feel better.

Sometimes a doctor can fix what’s broken, at others he can’t. Sometimes there really isn’t anything broken to fix. But making patients feel better is something he can do anytime. To do that, he needs to know exactly what was making them feel bad to begin with,

Everyday practice brings many examples of why patients benefit when doctors know what patients think:

• Kelly is afraid that the treatment is dangerous. Her friends, family—and of course the Internet—make her think so. So she doesn’t use it. Treatments work better when you use them.

• Jim belongs to an alternative health community. He takes medical cues from many sources other than his doctor. To avoid confusion and conflicts, his doctor should know what these other sources say so she can negotiate with them.

• Leo’s doctor thinks his acne is doing fine, but Leo does not agree. Unless his doctor convinces Leo to stay the course--it usually takes 10-12 weeks for acne therapy to work, and “working” means 60 percent improvement--Leo may well stop treatment. (See Kelly, above.)

• Tracy has a patch of psoriasis on her elbows. Her doctor is neither impressed nor concerned—it’s just one patch, after all. But Tracy knows that her mother hasn’t worn shorts or gone to the beach in years, and Tracy is worried that at age 27—too young!—she is headed the same way. Patients tell stories about their health lives. Doctors need to go beyond making diagnoses and listen to the stories behind them.

• Patients and doctors use the same words differently. "Immune system," "toxicity" (and "detox"), as well as "systemic" refer to quite different things when patients use them than when doctors do. Communication requires translation.

Medicine these days is being reduced to data collection and measurement: diagnostic accuracy, treatment effectiveness, physician quality. Many doctors spend more time facing computer screens than looking at their patients. Doctors can't effectively process what their patients are thinking unless they look them in the eye. Healing the body means mending the mind. 

By thinking like a patient, I don’t mean being empathic and nice. I am nice, and I hope you are too. All doctors should be nice. Thinking like a patient, however, means listening to opinions that are different from the way doctors look at things, and then speaking—and acting—in a way that makes sense to the person you are trying to help feel better, whether you can repair them or not. More than wanting to be repaired, patients want to be heard. 

Students who follow me around get the hang of thinking like patients. They can then decide whether that is something they want to continue to do. They see that doctors who think like their patients can ply our trade just as well as our profession expects us to, yet get to the heart of what ails the people we are trying to help. They see the way patients benefit too. “I feel so much better,” they may say, even if there wasn’t anything medical to “do.” 

Watch this space for further dispatches from the clinical front. No therapeutic breakthroughs, no miracle skin creams, no lasers that turn back the hands of time. Just ordinary folks with daily problems. My job is to listen to them, and you can listen in. 

Top Posts: April 2014