Human

If there is a central theme to this blog, it is this:  medicine is a human thing.
On the Facebook page of my podcast, I recently asked for readers to tell me some of the \”war stories\” they have from the doctor\’s office.  What are some of the bad things doctors do wrong?  I quickly followed this with the flip-side, asking readers to comment on the best interactions that they\’ve had with their doctors.

The response was overwhelming, and equally quick to both rant and rave.  They told stories about doctors who didn\’t listen, explain, or even talk with them.  They told about arrogance and disconnectedness from the people from whom they were seeking help.  They also told about doctors who took extra effort to listen and to reach out in communication.  They talked about doctors who genuinely seemed to value them as humans.

I have heard and experienced the other end of the relationship: of both \”good patients\” and \”bad patients.\”  The good patients are the ones who value my skill, interact and listen to what I have to say, and treat me with kindness.  The bad ones are the ones who demand beyond what is reasonable.  They expect me to jump when they say I should, put down my own personal needs, and perform miracles that I can only wish were possible.  This isn\’t a function of who follows my instructions; I don\’t consider patients who do what I say without any question as good patients.

The underlying theme is the same on each side of the relationship:

  • Patients want doctors who treat them as valued humans.
  • Doctors want patients who understand that they are only humans.

Patients want doctors who have empathy for their struggles, who value their perspective, and who respect their privacy.  Patients want doctors who understand the patients have lives outside of the doctor\’s office.  They don\’t want the doctor to treat them as \”just a job.\”  The patients are not there to give the doctor something to do; they are there because they need the doctor to meet a need.  Patients visit doctors because of the weakness inherent in humans, and they want the doctor to understand, respect, and acknowledge that fact.

Doctors want patients who understand that it is a person sitting across from them in the exam room.  We don\’t have magic wands, we are not the agents of God, we are not brilliant super-computers, and we have lives outside of the doctor\’s office too.  A doctor likes patients who want to share the responsibility of getting well, meaning they are willing to listen to what we say, ask questions, and if they agree with the plan, to follow our suggestions.  We also like patients to realize that they are one of many patients they see each day, of hundreds each month, of thousands each year.

Since it\’s an encounter between two humans, the expectation on either side should be realistic.  Doctors and patients are flawed people.  Both sides tend to forget this, breeding a lot of frustration in that process.

Doctors forget that patients are sick, tired, depressed, and weak.  This means that they may forget things or act out of irrational compulsion.  Some patients were traumatized as children, have nasty bosses, or have had bad experiences with previous physicians.  Irrational-appearing behavior is usually there for a reason, and that reason is usually not to annoy their doctor.

Patients forget that doctors have bad days, get depressed, are sometimes sick, and can be as irrational as patients.  We are forgetful at times, don\’t always think of things that may be obvious, and even get distracted at times.  Sometimes our kids annoy us, sometimes our marriages are bad, some of us have our own past trauma, and sometimes the patient immediately before your appointment was very difficult.

Human, meet human.

If this fact was really appreciated, considered, and accounted-for on each visit, both sides would be much happier.  I am not special; I am just a guy who doctors for a job.  It is a great job, an honorable job, and a difficult job.  But it is just a job.  I shouldn\’t think more of myself than that, and I should always remember that the person I am seeing is just as human.  I hope my patients remember this as well.

9 thoughts on “Human”

  1. Good post: and maybe all of us need to think about doing some forgiving, which is supposed to be the divine thing. A friend has been blogging a lot lately about corresponding problems in the business world, with people retreating behind so-called objective language to avoid interaction with other human types: http://tinyurl.com/y8fl2ny

  2. Dr. Rob, I'm trying not to comment every time you post something but this is your best post yet The way we treat each other as doctors and patients really is at the heart of everything. I was incredibly lucky to have four wonderful doctors guide me when it was my turn to get breast cancer–my family doctor, general surgeon, oncologist and plastic surgeon. Each one was mindful that there's a person attached to the breast. One day when I was trying to figure out what to do, everything my poor family doctor said rubbed me the wrong way. He left a voice mail for me at home later to apologize for not communicating very well. So I ended up leaving him a voice mail to tell him it takes two to communicate and I didn't hold up my end of the bargain either. But I'm blessed in that I've been seeing him for more than 15 years. I'm hearing that fewer doctors are going into primary care, and for that and other reasons the doctor-patient relationship is under siege—what is your take on that? We can do our part by being kinder to each other, but what is the system doing to help or hurt our relationships?

  3. Great post, Dr. Rob. I wonder if some of the myths about doctors — that they're all-knowing, superhuman, super smart and set several steps up the social rungs from the rest of us — come from past social mores. As a middle-aged person, I don't have the same awe of doctors that I had as a child, teenager and young adult, but then it seems like an awful lot of the doctors I meet these days are (ack!) younger than me. A lot younger. Since I've been their age, and they're no longer the “authority figures” in life, I know how human they really are. My mother was deeply respectful to my childhood doctor; she taught me by example how to behave when I was sick and needed help. I'm still that way, but now, when a doctor doesn't take the time to talk to me, to listen or recognize my humanity as well, I change doctors. It's that simple.

    Thank you for another thoughtful post. I love how the Internet allows us to talk to and learn about each other as equal, caring, fallible human beings, even though we're not talking face to face. It's a good and enlightening thing.
    -Wren

  4. Wow…I was just having a related discussion about this sort of topic in the comments of another physician's blog recently. As someone who's seen the patient side of this relationship a bit too often, I really enjoyed this post. I've had doctors over the years at all points on this “appreciation” spectrum; some were gracious to a fault (often with a little humor thrown in to cut the tension), others not so much. That ability to see people as fallible, needy humans without developing a God complex isn't something they can teach in medical school; I think some of it is character and some develops over years of clinical experience with patients.

    It was what I tried to remember recently when I had a relatively new (to me, not to practicing) doctor who I could tell was trying hard not to give me some version of the standard “if you lost weight, it would help” lecture in regards to my particular diagnosis; I worked hard to bite my tongue and not say something totally stupid or snarky in response to his commentary because the wannabe physician in me knew he was just a concerned physician trying to help and not being nasty or rude. Perhaps part of it is that when people are somehow impaired (as by physical or mental illness or disability or sometimes just by life's circumstances at that moment), they want to believe that the person who's going to help them out of it or through it is somehow superhuman and can accomplish anything.

    Again, Dr. Rob, you hit the essence of the issue. That combination of humor and thoughtfulness that I've seen over the years (I'd guess it's been 2 or 3 by now) I've been reading this blog must serve you well in the “real world” of medicine too.

  5. Chronically Ill

    I know my doctors are human and I appreciate when I they show some of their humanity to me–I have chronic illness and see six specialists regularly and one specialist often who primarily manages my disease. I know he's human. I've spent enough time with him to see many different sides of him. Even though I know they're human, sometimes my doctors feel superhuman to me because they're able to “fix” my physical problems in ways that seem like miracles to me and that I couldn't do without their help.

  6. What a great post.

    If only both sides could keep those things in mind. I've watched as my own doctor has had his struggles, and yet he's still caring for those patients that need him on a day to day basis. Plodding through the masses to help where he can. Patients need to keep in mind those things you've mentioned. Sometimes doctors need some help too.

    Good doctors are a treasure, but it cuts both ways – the doctors need to be reminded every now and then, that sometimes, that patient is feeling scared and vulnerable; it isn't the day to day grind for them. What's routine for the doctor, isn't for the patient. Listening and compassion will go a long way.

  7. Thank you for this post. As a physician who has been in and out of treatment for lymphoma since 1990, I have experienced life on both sides of the stethoscope.

    I haven't been well enough to return to clinical medicine since 1993. So I've been advocating for patients by encouraging physicians to think about each problem from their patients' point of view. For example, one of my regular columns discusses the stress for patients of false alarms: “Duds” http://tinyurl.com/OT-062507 (“View from the Other Side of the Stethoscope” in Oncology Times).

    I’ve also been advocating for physicians, encouraging patients to think about their physicians’ viewpoint, a perspective that could lead patients to reinterpret in more healing ways their physician’s remarks.

    ONLY 10 SECONDS TO CARE gives patients and caregivers an intimate and useful view of the world of their physicians and nurses when dealing with common problems and stresses that come up in doctor-patient relationships. 40 short stories deal with problems like the stress of waiting for the doctors' office to call with test results. Or the stress of missing an appointment, not remembering details of the medical history (and the doctor getting impatient), finding hope with treatment options are runnning out, and so on.

    I couldn't agree with you more: Mutual empathy can lead patients and physicians to foster healing physician-patient bonds. Thanks again for your blog and this post. With hope, Wendy

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