"Hey, Doc! How ya doin'? Look at how great this scar healed up! You did a fantastic job! Man, I LOVE this place! You look great! What are your kids up to these days? Did you lose some weight? Give me some more good news!"
I laugh and hold up my hand, but he is irrepressible. Had we initially met socially rather than because of his cancer, I realize that we would have quickly become friends. During his office visits, I can expect stimulating conversation, new stories about his family, and a shared confidence or two. I really enjoy his appointments.
And that worries me.
There are a couple of reasons for my concern. First of all, despite the fact that physicians should care deeply about the health and well being of
all of their patients, the therapeutic relationship is not based on “friendship.” Physicians must be vigilant and objective in ways that friendly relationships can disturb.
Second, physicians need to provide care with Justice. All patients who come to us, whether they look like us or not, deserve the same quality of care. Physicians must be scrupulously fair in the equitable distribution of their time and attention. It is clearly unethical to spend more time with a patient simply because they remind us of ourselves.
Medical blogger,
Kevin, MD, has a link to a New York Magazine
article that interviews several anonymous physicians. These doctors provide blunt, sometimes disturbing observations on everything from picking a doctor to medical mishaps. In response to a question on how patients can get doctors to pay attention to them, a gynecologist responds,
“The truth is, we’ll spend more time with patients we like. We’ll joke with them, we’ll laugh with them. You have fun with patients you like." He implies that being charming pays benefits. Interestingly, neither the interviewer nor the other physicians challenges him.
Someone once told me,
“It often seems that the worst medical care is given to VIPs and to doctors’ families.” It certainly seems to be true at times. Corners get cut. Potentially embarrassing critical questions are left unasked. Treatment is too hesitant or too aggressive. In an effort to be both a physician and “something more,” things can happen.
My easygoing, friendly patient sits grinning at me. I truly am happy to see him, but the alarm bells go off in my head. I keep a "safe" distance, keep to my checklist, and try, once again, to overlook how much fun it is to see him.
The following is feedback received for this blog:
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I agree with you. I find it harder to be objective if I become too "close" to a patient. And I regret often that I can not be a friend to that person, because some of them would be great to have as friends.
- Ramona Bates
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I agree with you that care varies depending on the interpersonal relationship between physician and patient. It's a complex interaction - and the patient's personality and treatment preferences (do they want "everything done" or want to try the "wait and see" route?) can (and sometimes should) influence management. It's ok if you spend more time chatting with one patient more than another - but we need to make sure that the full range of treatment options are explained to all patients as we help them navigate to the choice that's right for them.
- Val Jones
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This was an interesting post. I realize that the original intent was to encourage physicians to be fair in how they allocate their time between patients.
However, there are lessons to be learned for us patients as well. After all, how often do we hear from people who feel they don't get the attention they deserve from healthcare providers?
Maybe the answer is... if you want more attention from your doctor, try being a better patient.
(I feel a blog post coming on...)
Great blog, btw. Keep up the good work.
- Dean Moyer
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just wanted to say thanks for a great post... usually don't see this amount of ethical consideration of these matters (time and objectivity) ... these are same issues i myself wrestle with in own life in different contexts... same principles can be carried over into other situations.
- w mersy
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