I saw a new doctor last week. My last doctor appointment was five years ago. Both visits were, ostensibly, for the same reason: I needed the prescription on my asthma inhaler renewed. Other than my asthma, which is very mild, I am healthy. I’ve had a fever twice in my adult life. I’ve never had the flu. I’ve never broken a bone. But that isn’t the only reason why I avoid going to the doctor. I simply don’t like doctors. It isn’t fear, it’s dislike. In my, albeit limited, experience, doctors are arrogant, condescending and cold. They don’t find me interesting, they treat me with very little respect. Why in the would would I chose to spend time with them?
In his book Blink, Malcolm Gladwell talks about doctors who tend to be sued verses ones who don’t. (link here) In the end the difference has nothing to do with the competence of the doctor – it has to do with whether the patients like the doctor or not. Kind, sympathetic, caring doctors don’t get sued. Cold, arrogant pricks do. And it serves them right.
I just read an excellent novel, Florence Gordon by Brian Morton. (link here) Florence is an old lady, and at one point in the story she visits her doctor, Noah.
“Florence Gordon,” he said. “My hero. My heroine.”
“You always seem amused when you see me, Noah. Do all your patients amuse you?”
“My patients don’t amuse me. You don’t amuse me. What you are mistaking for a smile of amusement is a smile of admiration.”
[skipping a few lines]
While they were talking he was listening to her body with his stethoscope, testing her reflexes, pressing on her lymph nodes. He had a knack of making you feel as if you were spending twenty minutes doing nothing but joking with him, even while he was examining you scrupulously.
I often read passages like this in novels where a doctor and patient have clearly known each other for a long time. They respect each other, care about each other even. But this is only ever in fiction, which makes me think I am not the only one who would wish for this sort of relationship with the person whose job it is to help me maintain my body.
But perhaps this is my own fault: I move, I change insurance plans, I stay healthy. The only doctor I’ve ever seen on a more regular basic was the gynecologist I had for most of my 20s and 30s. After a decade of seeing her at least once a year, sometimes more often when I had issues with birth control, or the occasional irregular pap or whatever, she never once remembered my name. And she was friends with my sister-in-law! She had the bedside manner of a dead fish. Even her hands were chronically cold.
I get the need for distance. If a general practitioner spent the amount of time necessary to truly establish a meaningful relationship with every patient, they’d see only a handful of patients a day, and never make any money. They might as well become therapists.
And there’s another bunch of doctors I can’t stand. Again, I’m only talking about my own limited experience, but when I, a pathologically honest person, starts making up insane lies just to get a reaction out of the person with the blank expression sitting across from me, you know there’s a problem.
I found a ‘discussion prompt sheet’ on a site called teachwithmovies.com for the movie, Good Will Hunting. (link here)
Here is question 8 from the attachment disorder section:
What does Sean McGuire, the therapist, try to do in the treatment?
Suggested Response: He re-parents Will. Sean tries to fill in the gaps of Will’s development caused by the abuse and the lack of caring. He provides Will with a secure attachment and with an oral history of relationships that worked by recounting his own. Sean told Will about life’s imperfections and that imperfect people could be loved. (Will thought of himself as profoundly imperfect and unlovable. Why else would his caregivers hit him?) Sean talked to Will about what sacrifice means, like a father to a son. Sean hugged Will, giving him the tactile sense of belonging that a child would get from a parent.
Which sounds just lovely, doesn’t it? But it is total BS. Granted, I in no way have any of the problems Will had in that movie, but not one of the therapists I have ever encountered would have committed themselves so thoroughly to solving my problems. They sat and stared and waited for the hour to be over. They did not care about me at all. It is my understanding that they are taught to keep a distance, to do otherwise would overwhelm them. But what I felt was disrespect and the feeling that I bored them.
I did a bit of research online and found that the idea that doctors should try to develop some sort of relationship with their patients has been in and out of fashion since the beginning of doctors. I found a paper from 2006 called “The evolution of the doctor-patient relationship” by R. Kabaa and P. Sooriakumaranb (link here) Not too hard a read for a scientific paper. A lot of it is quoting other sources, so this might be confusing, (links within links!) but I want to quote this paragraph
More recently, Roth and Fonagy (1996), [link in original] emphasized the importance of aspects of the doctor-patient relationship, including (a) the patient’s perception of the relevance and potency of interventions offered, (b) agreement over the goals of treatment, and (c) cognitive and affective components, such as the personal bond between doctor and patient and perception of the doctor as caring, sensitive and sympathetic. [link in original] Thus, a friendly and sympathetic manner may increase the likelihood of patient adherence to treatment.
This paragraph sums up exactly why I will be following my new doctor’s advice to the letter. a) Because she treated my disdain for certain medications as legitimate – and countered that argument in an intelligent and respectful way – I am willing to believe that a certain drug might be useful for me to try. b) We agreed that the goal of taking the medication was to make my life easier. c) Because she was caring and sympathetic and empathetic – and willing to get involved – I am willing to do everything she wants me to do.
“Thus, a friendly and sympathetic manner may increase the likelihood of patient adherence to treatment.”
Absolutely.
I want to be noticed. I want to be remembered. I want the doctor to think later, ‘Wow, that new patient Jill was a trip, I hope she comes back.” I want a doctor who likes and respects me. I want a doctor who sees me as the complex, multifaceted and interesting person I know I am. I don’t want to be reduced to a bunch of notes on a chart.
“‘Florence Gordon,’ he said. ‘My hero.'”
Mind of a Mouse 