Partner with your patients
I think a very healthy concept in the practice of medicine particularly regarding the doctor patient relationship is that of establishing a partnership with your individual patients.
The idea is that the patient and doctor should be on equal ground in formulating a plan for the patient’s medical care. The doctor’s role is to serve as an educator and advisor and to provide compassionate support. The patient’s role is to be honest and forthcoming in helping the doctor understand his/her symptoms, being involved in the discussion of various options, and letting the doctor know his/her preferences after the pros and cons have been carefully explained. Together they form a partnership with the common goal of making the patient better.
This works extremely well when both the doctor and patient are willing to enter this type of relationship in good faith. It breaks down quickly when one or the other becomes authoritarian or manipulative.
Don’t be a dictator
The authoritarian influence in the doctor patient relationship usually, but not always, occurs on the side of the physician. We need to guard ourselves from becoming too dictatorial, or even paternalistic, with our patients.
Some would say we have to be authoritarian sometimes to get patients to do what they are supposed to do. Spouses often ask me to “lay down the law” to their husbands or wives about some behavior that they would like to change, saying, “S/he will listen to you if you say it”.
Unfortunately, I have never found that to be the case, perhaps because I have personal difficulty being an enforcer to another person whom I regard as my equal. I can be encouraging, and I can often provide very good explanations as to why a certain behavioral change may be in the best interests of my patient. But I certainly have no way of enforcing it. Trying to do so through a verbal confrontation from a pedestal will only lead to anger, frustration, resentment, rebellion, and decreased sense of self-worth or possibly even depression.
I have no doubt that a physician’s words to his/her patient carry a lot of weight, or even power, some would say, but abuse of this power will not result in better patient care, and more times than not, it will be harmful to the patient and to the doctor patient relationship.
Having said that, there may be times when your patient’s judgment and/or ability to process the information and advice you give him/her is impaired. The patient may not be able to comprehend what is in his/her best interests. Even then, you should not become authoritarian in your demeanor and never, ever get in a shouting match with anyone. It won’t help and will only serve to upset everyone involved, including yourself. In that case, if the person is not mentally competent, that needs to be documented, and further discussions regarding the patient’s care should be undertaken with the next of kin or power-of-attorney.
The doctor patient relationship is a special bond that is different than any other. Friendship, concern, privacy, trust, empathy and equality are all involved at the same time and should all be carefully respected. If you partner with your patients in discussions about their health care, they will be much happier, you will be happier, they will get better care in the long run; and families will hopefully understand that you can be an encouraging adviser, but you can't be their enforcer without straining the bond.
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This page was last updated on August 7, 2010.