musings on the doctor-patient relationship

I was particularly struck by the humility of this week’s reading. Allen implies that doctors are fallible, and because of this, a “good” doctor is not necessarily one who is the best educated or the one with the best reputation, but one who cares, who will worry if they’re providing the best possible care to their patients. I was really amused by this thought, because if the measure of a doctor is his/her ability to worry, then I imagine that I will be among the best doctors in the nation! But seriously, I think this is really true, because a patient who receives the best treatment might leave the doctor’s office feeling somewhat unsatisfied, like there was some part of the relationship that was not fulfilled (“…that’s it?”). This ties into the issue of suing, because patients who have the sneaking suspicion that their doctor doesn’t care and isn’t doing all that he/she can are more likely to accuse their doctor of malpractice, which is an obvious indication of the lack of trust in the doctor-patient relationship. That aside, the meaningfulness that one gets out of the doctor-patient relationship is one of the primary reasons that people go into medicine. A doctor’s relationship with a patient may extend beyond the purely medical to social health, encouragement to engage in the community, and philosophical issues which I am definitely looking forward to.

At the same time, I think that it’s important for doctors to not see themselves as the person directly responsible (or guilty) for their patient’s health. Along with the tendency to worry comes the tendency to try to be a Superman for one’s patient, which may or may not be beneficial. A lot of Sandy’s stress could have been avoided if he had accepted having to wait for the test results, without which he wouldn’t have been able to offer good advice anyway. When can doctors care too much? Sandy wanted to do everything for his patient, but this was not possible. If he had been unable to restrain himself, he might have scared Steve, and also compromised his own authority as physician and been perceived as “unprofessional”—caring for his patients too much. In addition, he adds a lot of stress to himself that sets an even more idealistic standard of care for his patients in the future. Although much has been made of the “macho” tough-guy world of medicine in which doctors don’t admit their mistakes (which is obviously bad), it’s important to also maintain a high level of confidence in one’s own work, which I think naturally leads to increased optimism for the patient’s well-being. It’s in finding the balance that a lot of the controversy over the ideal doctor-patient relationship occurs.