If there is a cPicture 35entral theme to my work, 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.

ROB LAMBERTS is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player.  He is a primary care physician.

4 replies »

  1. It’s great that you understand that both patients and doctors are human and as such are flawed. However, doctors should be entering the profession with the knowledge that they have the responsibility to treat not just the medical problems of the patient but ensure that their psycho-social needs are addressed as well. If doctors are seeing hundreds of patients each month, it should not be unexpected when a patient is tired, depressed, or irritable. This is not a new development – having a chronic illness or being sick will do this to even the most optimistic of patients.
    As a patient, we do understand that the physicians treating us are human and will occasionally have bad days. The problem arises when everyday is a bad day for the physician and when the physician acts as though they are entitled to more simply because of their job title.
    Ultimately, physicians are in a customer service industry and as such need to make sure that all their customer’s needs are met. This means that you need to treat your patients like human beings, instead of just a number.
    I think an important issue to consider is that patients are investing a significant amount of trust into their care. Not only entrusting their personal health but entrusting the expectation that each physician is investing a personal interest into their well-being. I think in many cases patients are sensitive to the interactions that transpire between them and their primary care provider. In this case, actions do not always equate as highly as words. As a patient I would want to be under someone’s care who is not only knowledgeable, but personable. I don’t think it is too high of a demand for most to fulfill. However, it seems all too common for patients to report a dissatisfying interaction with at least one physician they have encountered. The component of ethics is to value the inherent worth of each invididual, which is the underlying ethical contract each physician is expected to adhere to. If that value is minimized from the patient-physician relationship, then we may as well resort to replacing physicians with computers or other technology. However, that direction would dismantle the current emphasis on quality of care.

  2. Nice words Dr. It was interesting to read an article about Dr. – patient relations. Individually, i hate being in hospitals, as patient or not. I think lots of doctors are careless.

  3. Oh that it was that simple – just the doctor and the patient. Unfortunately, there are other (unseen) entities present in that examining room that are unduly influencing testing recommendations and treatment: medical insurance companies, professional liability companies, guideline committees, pharmaceutical companies, etc. Then you also have the personal biases of the physician and the patient’s sometimes unrealistic expectations…
    I would love to find a physician I could trust to do what is truly best for me, taking into account my personal preferences regarding medical care choices. I don’t know if that person exists in today’s bizarre world of medicine!