When I think about the doctors I’ve had, the ones I think highly of are the ones who listened to me, answered my questions and took time to explain what the problem is. I also recall the doctors who I have a not so fond memory of.
In university, I broke my tailbone. At the time I was competing in triathlons. When I went to see the doctor I asked: “What do I need to do so that I can get back to my regular level of activity?” His response: “You never will be able to.” That was it, no rehab plan, no encouragement to keep working on getting better, instead just telling me I can’t. End of appointment.
I walked away feeling awful and with little knowledge of what to do so I just waited and gradually increased my activity levels as the pain would allow. After about four months, I was back training at my previous levels pain free and I have never had occasion to think I’ve been prevented me from doing anything I want to do.
While I can’t read the doctor’s mind, it felt like he gave me the brush-off. Maybe he didn’t want to spend the time talking to me in more detail, or maybe he didn’t know the answer to the question. Regardless, he answered in a way that ended the conversation. However, if there is anything I’ve learned in 20 years of medical research, is nothing is certain because each person is different, biologically and personally.
My personal thoughts on doctors are similar to what I’ve heard from patients. When they describe the doctors they like and dislike, it’s usually things such as he/she didn’t listen to me, or he/she gave me this prescription and I don’t even know what it’s for, or I really liked how he/she explained that <drug/diagnosis>, he/she was really supportive of me and listened to what I had to say.
The common thread among these comments is they reflect the personal experience and not the knowledge aspect. Even patients who say the doctor didn’t know what he/she was talking about, usually mean the doctor didn’t listen to the patient’s concerns. While it may be easy to counter patients don’t know about medicine to judge the knowledge of the doctor, I think it goes beyond that.
People want to be listened to and have what they say acknowledged. Have you ever had a disagreement with a sales clerk while shopping? Those clerks who don’t listen to you and just say that’s the way it is don’t make you feel very good. While a clerk who is patient, takes time to listen and maybe even checks with the manager, seems to make the experience more acceptable. The result of the two scenarios may be the same, but most of us will feel better cared for in the second one.
We want to have a trusting relationship with our doctors, but patients are at a disadvantage even before they enter the examination room because of the unwritten power dynamic in the patient-doctor relationship. The doctor is the authority on the topic and the patient isn’t. The doctor spent ten plus years in university to get to where he/she is, and the patient didn’t. There’s also a culture in our society that raises doctors above many other professions. Whose parents wouldn’t be proud of their son/daughter being a doctor?
This power dynamic can make many patients intimidated and it can be magnified if the doctor has an arrogant attitude, whether conscious or not. Sometimes this can come across as frustration by the doctor that he/she is having difficulty explaining to the patient, or even impatience if the patient doesn’t grasp what the doctor the saying. Some doctors spend too much time talking medical jargon that no one else can understand.
So how do we address this power dynamic? It’s not so much that our goal should be to abolish this dynamic but rather create a setting in which the patient feels comfortable in getting what he/she needs out of the appointment. This is easier said than done; often when we want something (such as medical care), we are in a naturally vulnerable position. In Part 1 of this blog, I discussed how writing points down before the appointment and bringing a family member or friend who can be your advocate, can help get your concerns across.
Most of us are going to feel more comfortable speaking to a doctor with a similar cultural background and/or gender as us. I’m more comfortable talking to a male doctor about male things. Not because I don’t trust the knowledge of female doctors, but there is value in experiencing similar aspects of being male. Just like a recently published study found that women were better treated by female doctors in the emergency room for their heart attack. It most likely comes down to comfort in discussing symptoms and the awareness on the part of the doctor.
I’ve often thought that being a doctor is more of an art than a science. While there is a lot of science that goes into medicine, being a good scientist doesn’t make you a good doctor. Qualities of a good doctor include being empathetic, a good listener and being able to provide information in a way patients can understand. I would say these are all skills of the arts, and it would be great if medical schools spent more time focusing on these attributes, which will likely improve patient care.