Who Needs the Relationship More? Many doctors claim the most fulfilling part of their job is the patient relationship. But do patients really want a relationship with their doctor? Many patients switch doctors whenever their insurance plan changes, and it's no big deal to them. So who really needs the relationship more? And why? To investigate, I interviewed 122 physicians who answered the question: "Who needs the relationship more: the doctor or the patient?" It's the patient, of course, claimed 42% of the physicians. Yet 17% of the physicians asserted that the doctor is the one who truly needs the relationship; 35% believed that both doctor and patient need each other; 3% said it depends on the specialty and circumstances; and nearly 3% believed that neither the doctor nor the patient needs the relationship at all. Arguments for Patients Being Needier "The patient is most dependent on the doctor—they need the relationship," states internist Allan Kelly, MD. "They are so much in need that they will pay money." For many physicians, a patient visit is merely an economic transaction—an honorable way to make a living. Whereas a patient has a greater need to relieve symptoms or treat disease, the doctor would have no job or income without the patient. Yet a therapeutic relationship between a skilled physician and a suffering patient is unique in its scope—it is even sacred—and it may transcend the superficial financial and physical encounter to involve a deeper emotional and spiritual connection. "I think the patient needs the relationship more," discloses family physician Steven Powell, MD. "I need the relationship for some sort of spiritual fulfillment. It is much richer than most other human-to-human interactions. I can take or leave any individual patient or group of patients. I wish them well and try to do what is right for them, and worry about some of them when I get home. But I don't have any prolonged attachment." "Proof of this to me is that I recently left my job of 10 years at a large multispecialty group," says Dr Powell. "On receiving my farewell letter, patients came in for weeks with outpourings of sorrow, disappointment, even tears. I was simply overwhelmed. I really did not expect that attachment. I was very moved and so very grateful. But I definitely did not cry—at all. I have been ready to move on for years and don't regret it." "As a primary care physician, I have a unique relationship with my patients," shares family physician Kevin Bluemel, MD. "I discuss things that nobody else, sometimes not even their spouses, talks to them about. I am allowed access to their deepest secrets. They willingly let me place my hands and fingers in places that they wouldn't let themselves or anyone else place them." "But I do this with 20-plus patients every day," Dr Bluemel adds, "whereas I am the only person that they discuss these things with or let do those potentially embarrassing things to. So I have that sensitive relationship with hundreds, even thousands of patients, whereas they usually only have that relationship with one person—me. Thus, I think the answer to the question is that the patient needs the relationship more." Realities of Doctor-Patient Relationships It's true. Doctors have thousands of relationships with patients, and patients have a few key relationships with doctors. "We are here to serve our patients," claims psychiatrist Lamis Jabri, MD. "Of course we need them too, but we can always find new patients. Our patients can't always find new doctors." "I suspect the patient needs the relationship more. At least, some patients do," says one anonymous physician, who explains, "I'm someone who doesn't seek 'a relationship' with my personal physician or with my patients. As a patient, I just want to get in, get business taken care of, and be done. Sure, I don't want a jerk, but this touchy-feely stuff is not important to me." As screen time and throughput increase, many docs don't have a free moment for any relationship. According to emergency physician James Speed, MD, "Patients benefit from continuity of care, although technically the question has no logical meaning owing to multiple false premises. The 'BIA'—bureaucrats, insurance people, and attorneys—doesn't allow doctors to benefit in any format except remuneration, and they are trying to take that away. In my world, the emergency department, we never get a chance to establish a relationship anyway." One doctor laments, "I'm too exhausted to need or provide any relationship." "Who needs who more?" asks psychiatrist Lisa E. Goldman, MD. "It had better be the patient, or I'm in big trouble. I have to be getting most of my emotional physical and psychological needs met outside my relationships with my patients. And it isn't realistic or possible to get one's spiritual needs met from my patients in concrete reality. But in the abstract, my patients most assuredly do nurture me when they accept the help I am offering." "It is my job to not depend upon the love, approval, or respect of each patient, although I do welcome it when it is there," Dr Goldman says. "I have needs too. But it's not the individual patient's responsibility to meet these needs. If it were, I would be running the risk of exploiting my patients." Arguments for Doctors Being Needier "I think the doctor needs the relationship more," explains an ob/gyn who requests anonymity. "My reasoning is the patient can change doctors as easily as changing socks. You are but a small fraction of their patient's life, even if they think you are the greatest doctor on earth. Doctors need and desire the relationship—that is why many went to school—to help people, and in that 'help' they envisioned a relationship." "One of the reasons I won't do clinical medicine anymore is because I would pour myself into my patients—anything they needed, whenever they needed it—at the expense of my family and my own life," says this doctor. "Then they switch to your partner, or change practices altogether, or file a malpractice suit. There is real heartache potential if you are seeking friendship and a reciprocal level of commitment." "Doctors become frustrated when they work so hard for patients who may take a passive approach to their own health—and put even less effort into developing a relationship with their physician," explains psychiatrist Jonathan Terry, MD. "Most patients don't want to be patients, but every doctor works his or her tail off to earn the privilege of having this professional relationship." "The physician needs the relationship more," says internist Rex Mahnensmith, MD. "That care is genuine, heartfelt, and heart-based, and not mechanical, not robotic, and not driven by productivity measures. In fact, it is the relationship that protects patients from one-size-fits-all medicine and safeguards physicians from malpractice suits. Patients don't generally file lawsuits against doctors with whom they have great rapport—even if the doctors make a mistake." Relationship-driven medicine is safer and more fulfilling than production-driven medicine. Family physician Rebecca Gallagher, MD, elaborates. "Without a good, high-quality relationship with their patient, the doctor cannot fully share or express their talents and gifts. I feel this is essentially what leads to extreme discontent and resentment in a physician, leading ultimately to a deterioration of their identity and well-being. This starts the spiral into anxiety, depression, and loss of self-esteem and self-worth." Arguments for Mutual Dependence "Relationships are not a contest. You cannot have one person in the relationship without the other," says family physician Chris Hatlestad, MD. "Both parties have different needs, expectations, and roles. Most of these—income and healthcare primarily—seem clear in a doctor-patient relationship. Clearly, some patients need more reassurance, guidance, compassion, empathy, or just a sympathetic ear beyond the mechanics of diagnosis and treatment." "Without a relationship, both parties suffer," says family physician Steve Ames, MD. "The patient will not get compassionate, connected care. The doctor will wither and be stunted in his or her ability to truly give care that is healing for the patient in physical, mental, and spiritual ways. The joy of practice evaporates without the relationship. Patients and doctors are being separated and pitted against each other. The relationship is being destroyed by population management and withdrawal from individualistic care." "The doctor-patient relationship is special and a unique form of attachment having to do with suffering and illness, health, healing, and death," says a doctor who wished to remain anonymous. "One might assume that the patient needs the doctor more because the patient is ill, vulnerable, and dependent. Without patients, however, doctors have no purpose. In addition, they are frequently not so good at the rest of life and, for a variety of reasons, fit best in the peculiar niche that is modern medicine. Of course, this is changing and becoming postmodern medicine, which has the doctors upset and depressed." "Both need each other," states general practitioner Tonya Townsend, MD. "It's like asking, 'What is more essential for a painting—the canvas or the artist?' The healer needs the sick. It is symbiotic in a sense." An Argument for Neither Needing the Other Whereas the patient relationship may be essential to a psychiatrist or family physician, some doctors believe that neither the physician nor the patient needs the relationship. Radiologists and pathologists, for example, rarely have the opportunity to meet the actual patient. How much of a relationship is possible during an autopsy? Can neonatologists really develop a relationship with a 24-week preemie? Their relationship is more likely with the parents. So what's the answer? Maybe doctors and patients both need each other, yet neither knows exactly why. "Both" is the answer, says family physician Carolyn Eaton, MD. "The doctor-patient relationship is a symbiotic one," she points out. "The doctor needs the relationship not just for the financial remuneration from services rendered, but for the affirmation that all those hours of training have been worth the effort to help others—the improved hemoglobin A1c, the lower blood pressure, or the lesion found as a polyp long before it could become cancer. Most important are the pictures of children, grandchildren, fur babies, and smiles. Patients receive information to make their health—and therefore their lives—better (should they choose to listen to us)." What Do Patients Want? Doctors spend a lot of time worrying about patients' perception of their relationship. We wonder whether the patient is happy. Lately, we worry whether we're getting good online reviews. Yet doctors may be projecting their own needs onto a relationship that may not be that important to the patient. What do patients really want from us? Reassurance they will be okay and won't die. Sometimes all the patient wants is a pill. Others are happy to hand over complete responsibility for their health to the doctor. The truth is that most patients just want to get better and may not be invested in developing a relationship at all. Physicians, on the other hand, may rely on the patient relationship for fulfillment and self-esteem. Maybe physicians are less interested in the relationship and more in need of validation. Of course, patients have no idea that doctors need validation, and doctors seem so distracted by the pressures of productivity that they're unable to be fully engaged and present in the relationship. Source
