“Few patients realize how deeply they can affect their doctors,” notes Dr. Scott Haig. In his Time Magazine article (10/5/2007) he goes on to say, “That is a big secret in medicine, which doctors hate to admit. We think about, talk about and dream about our patients. We went into clinical medicine because we like dealing on a personal, even intimate level with people who have chosen to put their bodies in our hands. Our patients make or break our days.”
“Take the compliment,” Dr. Haig tells us. “Our career choice means we really do think that you—with your aches and pains—are more interesting than trading securities, more fun than a courtroom full of lawyers.”
This revelation brings to mind the words of Laura Byrne from our Difficult Conversations video. She lets us know that “Doctors have a hard job. Not everyone wants to have these [difficult] conversations…some people do.” She is referring to a discussion about her prognosis. As patients, do we stop to think what it’s like to deliver bad news or not have answers?
Dr. Haig’s article highlights the doctor’s experience, which is a balancing act. On one hand doctors must be objective clinicians but they are also touched by their patients’ anguish over living with uncertainty. And, as Laura Byrne implies, doctors are not mind readers and can find themselves in a dilemma as to how much information a patient would like. In such instances, they are imagining themselves in the patient’s skin. To imagine is not to know.
The doctor-patient relationship is very complicated and prone to misunderstandings. It seems to me that best care takes each “helping” one another on this journey. The only way you can do that is with open and honest communication.
So, what can patients do to help their doctors? Dr. Haig offers one suggestion, “Massaging the ego is the key to manipulating responsible types like doctors. When we feel your trust you have us.” I have often advised patients to say, “I need your help.” I do not agree with Dr. Haig that such a message is manipulation but a reminder as to why they went into medicine. These words can humanize the medical encounter.
I’ve just been teaching Tolstoy’s immortal “The Death of Ivan Ilyich” in my Literature & Medicine course at Rutgers, and the reluctance of Ivan’s doctors to tell him the truth (assuming they knew it) reminds me of my late husband’s early days with a differential diagnosis of Alzheimers or frontotemporal dementia; one doctor emphasized the ambiguity of the diagnosis while airbrushing the dire nature of the news she was giving us. It’s easier to say “Well, it’s either A or B…” than to look the patient and caregiver in the eye and say “I have difficult news.”
Thank you, Celia. As always!
Another beautiful and important piece! Bravo!
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