“The dermatology profession exists for the primary purpose of caring for the patient. The physician-patient relationship is the central focus of all ethical concerns.”
– American Academy of Dermatology, Code of Medical Ethics.
The doctor-patient relationship is one of profound importance and complexity. And while doctors in training often receive quality mentorship regarding their chosen specialty, many lack good mentors to guide them in the art of the doctor-patient relationship. This is because most medical students and residents are trained first and foremost to maximize profit for the institution where they are trained. Consequently, many young doctors often graduate from their residency programs with little to no understanding of what constitutes a good doctor-patient relationship, and why it is so important — not only for the emotional well-being of the patient — but for the well-being of the doctor. Indeed, if we fail to pass on the significance of this unique and foundational relationship, the divide between the doctor and the patient will continue to widen, as the road to bitterness and lassitude engulfs us all.
The presence of unwanted observers and an absence of informed consent regarding common long-term side effects from chemotherapy and other powerful drugs can obliterate the doctor-patient relationship like a Hellfire missile crashing into an old Lada. However, there are also more subtle things that doctors should take note of that can likewise significantly impact the physician-patient relationship. Indeed, a doctor in training learns how to establish a good rapport with their patients, not through artifice or trickery, but through a genuine desire to establish a sacred trust. They are simultaneously acquiring respect for medical ethics.
It is important to set aside all electronic devices during doctors’ visits, and this includes the computer. Unless the doctor and patient are going over a scan together, the office visit is a place where technology will drive a wedge between people. One can always take notes and type this information into the computer later. If a nurse, medical student, resident or fellow first meet with a patient to touch base regarding the patient’s health, they should be in and out of the room as quickly as possible. These individuals often linger far longer than they should, which invariably results in less time that the patient will actually spend with their doctor. Clearly, this can weaken the physician-patient bond. It can also result in confusion and ambiguity, as the attending is then briefed on the history, receiving this information second hand. Considering the fact that getting an accurate diagnosis can be a complicated affair — wouldn’t it be logical for the physician to get the history or updated history directly from the patient?
Doctors should always make an effort to return phone calls, and one should never assume that a patient is calling about a trivial matter. In New York City, it is very common for nurses to be charged with the task of calling patients back. The problem with this is that nurses seldom possess the ability to flag something as important in the way that a doctor will be able to. As many doctors do not return phone calls, this small gesture will undoubtedly be appreciated.
Another thing that can degrade and debase the doctor-patient relationship is to instruct secretaries, who are not licensed health care professionals, to obtain patients’ questions over the phone. By asking the patient for a detailed question, the secretary is essentially asking the patient for a breakdown of their symptoms, and these are people that lack any medical training whatsoever. In addition to this being intrusive and inappropriate both from a professional and an ethical standpoint, it is also a recipe for a cascade of miscommunications, as the secretary passes the message on to a nurse, who then passes the message on to a resident or fellow. By the time the attending gets the message, it is often horribly mangled. What right does a secretary have to ask a patient about the status of their ovarian cancer? Many patients are so turned off by this that they simply give up altogether. This is an example of how physicians sometimes unknowingly create barriers to communication that can alienate, embarrass and rankle patients.
A doctor is neither an auto mechanic nor a plumber and a person who interacts not with things, but with human beings. Consequently, doctors should always make an effort to ask patients what is going on in their life outside of the world of medicine, as this will help the physician get to know the patient as a complete person, which can, in turn, facilitate a better rapport. While this may seem self-evident, it is paradoxically the exception rather than the rule. Understanding why it is necessary to keep these channels of communication open will not only result in more compassionate care but can also help physicians determine what is actually ailing their patients.
Instead of being exploited and used as cheap labor — medical students, residents, and fellows should be given the opportunity to experience a certain continuity in developing relationships with their patients. And they must be taught with an understanding of how things such as listening, respecting patient privacy and confidentiality can be as important as reading a CT scan or an EKG. Physicians that have a cavalier attitude regarding the former have embarked on a road to perdition.
Granted, doctors have become cogs in a for-profit system and have, in many ways, lost their autonomy to private health insurance companies, hospital administrators and the pharmaceutical industry. Nevertheless, there are still significant things that doctors can do to help keep the doctor-patient relationship alive. Unlike surgical outcomes, a sound doctor-patient relationship is not something that is statistically quantifiable. And yet without this human rapport, something inimitable and timeless — a sacred human connection — will be lost forever.
David Penner is a writer.
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