Among all the skills a physician needs to learn, balancing the doctor-patient relationship can be the most challenging. To make things harder, medical students are receiving conflicting messages. On one hand, you’re taught a patient-first philosophy: the customer is always right, empathy is key, and their needs come first. On the other hand, you’re told to have all the answers, deliver the facts, and to look after your own health to avoid burnout. So which is the better approach? What are the ethical implications involved? Is there a middle ground? Here are some dilemmas physicians face regarding the doctor-patient relationship and tips for finding a healthy balance: A case for the patient-first philosophy: stereotypes Even in our diverse world, prejudices still play a big role in the doctor-patient relationship. Especially in a field where so much is at stake, stereotypes surface where they otherwise might not. For example, anxieties are much higher in a high-stakes profession than in other service-based scenarios. As a result, minority physicians are often encouraged to dilute some aspect of their identity to make patients more comfortable. One Indian physician was encouraged to shorten his name from Vikram to Vik so that patients would find it easier to communicate with him and feel more at ease. While many consider this an injustice, and rightfully so, this physician holds a different view: “The physician-patient relationship is still fundamentally asymmetric with the physician decidedly holding the power. Why wouldn’t a patient grasp at some kind of connection with their doctor to minimize their fear?” He raises an important question of whether it’s more helpful to insist on our differences or rather focus on our similarities when connecting with patients. A controversial issue to be sure. A case against the patient-first philosophy: drug crisis Another prevalent issue in medicine today is the opioid addiction crisis—patients are overestimating pain and physicians are over-prescribing meds. While both doctors and patients are contributing to the problem, valuing customer satisfaction over patient care is a major factor. Doctors are so quick to please their patients or receive good reviews on Yelp, that they go against their better judgement and training to keep their patients happy. This is no trivial matter. Last year alone, 52,000 young Americans died because of a drug overdoses, including prescription drugs like oxycodone, codeine, and morphine. This begs the question of what it means to truly care for our patients. Perhaps, in addition to protecting them from disease, physicians are also called to protect them from themselves. As one emergency physician puts it, tough love is what sets quality patient care apart from cheap customer service: “Disempowering doctors and forcing them to cater to the whims of patients has contributed to overprescribing narcotics and over utilizing lab and radiology tests. Let’s untie hospital payments from patient satisfaction and return our focus to healing patients rather than pleasing them.” Reconsidering the doctor-patient relationship: testimony Improving any relationship requires the ability to put yourself in the other person’s shoes. That’s certainly been true of Professor Basil Porter—a man who’s had extensive experience as both a physician and a patient. After retiring from an accomplished medical career and facing many of his own medical ailments, he was able to experience first hand what patients desire. The main thing he discovered is that quality care is more about the approach improving the doctor-patient relationship is not about what we’re doing, but how we’re doing it. Putting the patient first is not about what decisions are made, or who gets to make them, but how we work together to arrive at those decisions. The more our patients feel understood and reassured, the more they will trust us to exercise our expertise. Once we give up the power struggle and realize we’re on the same team, everyone wins. As the saying goes: people don’t care about what you know until they know you care. Source
