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Key points
- The patient-doctor relationship is an important aspect of treatment.
- Patients and doctors are both human and their flaws play a role in their relationship.
- The relationship between patient and doctor has no room for bias, discrimination, or pre-conceived notions.
A patient’s relationship with their doctor is different than the doctor’s relationship with their patient. That there are two different relationships is often what underlies the efficacy and the success of their work together—their work being, of course, the improved health of the patient.
This shared goal of the health and quality of life for the patient is what makes this a critical and important relationship. There must be reciprocity between the two sides. It is not necessarily symmetrical but there needs to be a level of acknowledgment and certain assumptions from each party. There is no hierarchy.
There must be an acknowledgment and an assumption on the part of the doctor of the sincerity and authenticity of the suffering of the patient, and the resultant changes in their lives, including their relationships with family members, friends, and colleagues, and their ability to engage in activities and tasks as they had prior to their illness.
And there must be an acknowledgment and an assumption on the part of the patient that their doctor is human and, like all humans, has had suffering to some extent and has frailties and capacities that can change from day to day, and are very much dependent on what else may be happening in their professional or personal life.
Obviously, an important dissimilarity is that doctors have chosen to be doctors but no one chooses to be sick; this is inherent in the interaction.
Compassion and kindness toward another human being can be the spark that diffuses tension and conflict between two people, groups, or communities. We all yearn to be nurtured and cared about. Human connection is necessary for life and health and is the underpinning of the distinctive relationship between a patient and a doctor.
A doctor can sense when a patient is mistrusting and this may affect the disposition of the doctor and change the energy of the relationship. Similarly, a patient can sense when a doctor is not vested in their care or is distracted, and this too can have an impact on their bond.
The bond between a patient and a doctor can be tenuous but it can also be a source of great support. Some of my greatest experiences as a doctor are from deep connections with my patients. The art of medicine is lost today because of external controls of patient care and the ability to connect with a patient has been compromised. But it can still be obtained.
In medical school, we are trained to interview patients: Ask questions. Get answers. Fill in the algorithm and arrive at a diagnosis that will guide the treatment and discussion offered. It is recommended to not ask open-ended questions, as that may lead us off track of the purpose of the visit.
While there is certainly some truth to that and doctors need to be sure they are identifying and addressing the chief concern of the patient, this approach does not readily lead us to learn the patient’s story.
Everyone has a story that tells who they are, where they come from, how they think, and how they interpret the world around them. It is within this story that someone’s core being resides and where we can better learn what they are about. And understanding of that core can greatly help a doctor guide the conversation with a patient. Each person is something more than their symptoms and something more than their disease.
Learning the patient's story can further dispel any preconceived notions held by a doctor, as this relationship has no room for biases or discrimination.
Similarly, understanding even a piece of the doctor’s story can also improve the patient’s understanding of the doctor. But the patient rarely gets to learn the story of the doctor as a human. That is not the purpose of the visit, and it is not commonplace that a doctor’s story is told.
Both the patient and the doctor have a role to play in this relationship. The patient’s role is to explain what they are feeling and what they are experiencing in terms of physical and mental health, and certainly to advocate for themselves. The doctor’s role is to listen to the patient and work with the patient to help understand why they are feeling unwell and find therapies to help them improve their health for both the short term and the long term. This can be a journey, one that is so much more gratifying when the relationship is solid.
Real satisfaction comes from the alliance of the two toward a shared goal with a mutual understanding, dedication, and trust that both are human and both need support, albeit at varying levels.
These are excerpts from my forthcoming book.
