A guest column by the American College of Physicians, exclusive to KevinMD.com.
In many ways, the patient-physician relationship is seen as being mostly one-sided, with doctors possessing medical knowledge and wisdom, and patients with less medical information being in a position where they need a physician’s help and guidance in managing their health issues. Consequently, information transfer and advice have traditionally been perceived as flowing primarily in one direction – from doctor to patient.
However, this unique power relationship between patients and physicians belies the fact that doctors can, and indeed must, learn from their patients if they are to realize medicine’s foundational principle of entering into caring partnerships with them that prioritize basic human dignity and respect, and foster kind and compassionate care. And that learning from patients has the potential to impact who we are as both doctors and humans, and can profoundly affect our personal well-being.
Although we may not think about it, our learning from patients actually begins early in medical training. Beyond basic medical school classroom and laboratory study, we learn how to realistically practice medicine from individual patients, essentially on a one-by-one basis. They are our best teachers because although a disease process may have universal characteristics, it manifests itself uniquely in each patient, and only by understanding how the disease presents and affects individuals with different genetic and personal histories can we learn how to diagnose and treat it effectively. The importance of this learning is captured in William Osler’s statement that “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.”
But patients are also essential in teaching us so much more about the non-scientific aspects of being a physician.
The very nature of health care is that it invariably occurs in the context of a web of interpersonal relationships and often complex emotions, and that if we truly want to put patients at the center of care, we need to understand how medical illness impacts our patients as individuals and those around them. Only then can we apply the science of healthcare in an empathetic and compassionate way as our understanding of these less tangible aspects of patient care provide a truly humanizing effect on our practice of medicine.
But there is yet another aspect of learning from patients that we need to recognize and appreciate. It is one that extends far beyond training and permeates our careers as physicians, often gaining meaning and importance to us the longer we practice. These are the “personal” lessons that each of us as physicians, but also human beings, learn from engaging with patients over time.
One can’t help being affected by walking with and partnering with patients as they navigate both health and disease, participating in and sharing both the rewards and tragedies they experience as they journey through their lives from a unique perspective available to almost no one else.
What each of us takes away from these shared doctor-patient experiences will certainly differ depending on the type of medicine we practice, the patients we see, and our openness to letting ourselves be a part of this opportunity for personal growth afforded to us as physicians.
For me, working with patients has caused me to increasingly value the human connections that are essential to maintaining good health and managing disease when it occurs, including my own. It has brought into focus the fragility of life and the vulnerability to health issues we all share, doctors and patients alike, and the anxieties and fears each of us experience when confronted by them. I’ve come to appreciate the marked differences in the abilities of patients in dealing with their health problems and the practical and emotional issues that accompany them, and in the process have been compelled to examine my own response to the inevitable health challenges we will all eventually encounter. Having the opportunity to care for patients through the end of life has also challenged me to confront my own mortality and think of how I want and hope that process will occur for me and how it will impact my loved ones. And perhaps most importantly, observing the strength and resilience of patients in dealing with difficult medical issues and their ability to manage adversity has provided me important lessons about valuing life and health as much as we are able and attempting to live each day to its fullest. These shared experiences with patients over time have taught me much about listening, being present with others, and acceptance of what life has to offer, and I am grateful for the opportunity to learn from them.
I doubt that patients perceive the value of what they can, and do, teach us. But the lessons learned through engaging in their lives help make us the doctors we are, influence the way we care for others, and can be a great source of personal enrichment and well-being if we are willing to take advantage of them. From this perspective, in many ways, we need our patients as much as they need us.
Unfortunately, many of us ignore this bi-directionality in the patient-physician relationship, or simply choose to focus on the scientific learning from patients without appreciating the potential personal rewards it can bring, something completely understandable in the rapid-fire context of contemporary medical practice. But if we take the time to more fully engage with – and learn from – our patients, doing so will make us more kind, compassionate, and appreciative doctors, and ultimately better human beings.
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