There are three things that are bothering me this month as I contemplate this editorial and the beginning of a new year. The first is, I am getting older. OK, I can’t do anything about that.
The next is that I am spending more time in specialty offices than I care to—another thing I can’t seem to do much about.
The third thing that’s bothering me is being both a clinician and a patient. For many clinicians, their role as healer precludes thoughts of ever getting sick themselves. When they do, it initiates a profound shift, not only in their sense of self, which is invariably bound up with the invincible role of clinician, but also in the way that they view their patients and the clinician-patient relationship.
We have all heard that “doctors make difficult patients.” I suspect that is true for most clinicians, and I am no different. Perhaps it is because the role reversal is so profound, or perhaps it is a perceived loss of control or … dare I say it? … trust.1
While a number of books have been written from a first-person perspective by clinicians who get sick (eg, Oliver Sacks), and even though TV shows like House and a number of great movies (like The Doctor with William Hurt) touch on the topic, it never really means anything until it happens to you. So I am taking this bully pulpit and selfishly giving advice to those clinicians who take care of me—or any of us. Here goes.
1. Please do not come in, sit down, and start filling out the electronic health record (EHR) without introducing yourself. In fact, do not spend more time filling out the EHR than you do talking to (or looking at) me. Actually, forget the EHR! Do the history and physical, then leave the room and fill out the EHR. (OK, I realize I may have just stepped over the line.)
2. When you see me as a patient, please ask me what I do for a living. It is important to me to know that you care about what I do and it should be important to you, if only as part of an occupational history, to know what I do. Bernardino Ramazzini, who is considered the father of occupational medicine, aptly emphasized the importance of knowing your patient’s work environment.2
3. Do not assume anything. Please don’t assume I know what’s wrong with me. If you’re explaining something to me about an illness, a disease process, or a test, don’t assume I understand it all just because you know what I do professionally. Do not assume that I understand all the reasoning of your subspecialty. I might, but please make sure I have as much information from you as you would give patients without my medical background. Like all patients, I would like you to treat me as you would if I were your family member.
4. Having said that, I would ask you to gear your communication to a higher level of knowledge. Respect my fund of knowledge, but give me as much information as you would any other patient. I am there because I want to be a patient. I am there to get your advice. If you know I’m a clinician, either because you asked or I told you (to avoid being talked to like a fifth-grader), continuing to assume that I don’t know anything can be a patronizing approach. On the other hand, don’t assume that I know everything, as my condition may be outside the areas that I know much about. This could leave me clueless, unless I ask for clarification. Either way, if you ask me how much I know about a particular disorder and its treatment, and then tailor the talk to my knowledge level, the conversation will proceed much better.
5. Make it easy for me to have full access to my medical records.
6. After taking a history, ask me if there is any other relevant information that has not been covered. Always ask me what I think and what my preferences would be. Engage me in shared decision making.
7. Please don’t assume I know what you’re thinking. Do not avoid the “hard” behavioral questions.
8. If I have a serious diagnosis, it does not matter if I am a clinician; it is still a devastating diagnosis. Don’t treat me like a clinician at that point; treat me like a human being who just got bad news. Most likely I can start to formulate nasty scenarios faster than a nonclinician patient, so be prepared to be honest and realistic, but supportive and caring. Yes, caring!
Lastly, I am of the opinion that clinicians need to take great care to be objective and even a little detached in spite of their nature. There is always the tendency to give patients what they want instead of what they need. Please don’t confuse compassion with medical servitude or with a desire to be liked.
These cautions aside, the clinician who is compassionate will be much more therapeutically effective, to my mind, and more thoughtful in patient care than those who are not, and will be highly regarded among patients and colleagues alike. I highly recommend it!
I’d love to hear about your experiences as a patient and/or your advice to clinicians who are seeing you (send an email to PAEditor@qhc.com). Thanks for listening!
1. The art of patient care: compassion in patient care (2011). www.art-of-patient-care.com/compassion.html?&lang=en_us&output=json. Accessed December 17, 2012.
2. Bernardino Ramazzini (2004). Encyclopedia of World Biography. www.encyclopedia.com/doc/1G2-3404707887.html. Accessed December 17, 2012.