What Makes A Doctor-Patient Relationship

Power

Image by JAS_photo via Flickr

In our last post, The Struggle in A Doctor-Patient Relationship To Not Get Personal, your comments were critical to bringing it all together.  So much so, that I think it’s worth our time to review the main points about the doctor-patient relationship.

1.  People wonder about how to relate or conduct themselves.  It’s not clear and there are no directions.  In fact, for something so objective, why isn’t it?

  • a subject I have often wondered about – Cindy Taylor
  • when I see the new Doc, I just tell my story and describe symptoms????  – Sekan Blogger
  • hope that those professionals would be much more upfront with their patients – Nancy

2.  The professional distance itself between doctor and patient lends to the healing process

  • The doctor patient relationship is one thing that makes healing possible – Pattyann
  • if friends could help me I wouldn’t need to see a professional… – Patricia
  • distance …is such a strength – Kate Shrewsday
  • something far more greater than what a friend could provide and if I knew the intimate details of her life, that would have changed – S Sanquist

3.  The exchange of money for service is generally part of its constitution and brings motives into question.  Is there a price for the value of a patient’s health or even life?

  • You better keep me alive or there will be less money for you to make – Carl D’Agostino

4.  Power Imbalance

  • health professionals and I are not on the same social level when I am the patient and they are my health provider – Val
  • It (is) a loss to move from friend to patient. That is just how it has to go in the self-care process. Then there is the anxiety of the Dr. discovering who you really are and perhaps being disappointed. – M
  • same fine line in the teaching profession – Sarah McGaugh
  • most of my relationships have some sort of power imbalance – Shout Abyss

In truth, all relationships have an imbalance of power.  In healthy personal relationships, there is a flux in power, back and forth.  It’s a problem if they don’t pulse and is possibly one of the signs of an abusive relationship.

However, this doesn’t hold true in doctor-patient combos.  They are imbalanced by design and stay that way.  It feels counterintuitive at times to those involved.  But a good physician is like a good book – he/she/it is there for Me.  It is a unidirectional relationship.  There aren’t many good unidirectional relationships otherwise, …except for all those others.  You’ve heard of police, cashier’s, housekeepers, entertainers or, for example as Sarah reminded us, teachers.  But these are professional relationships and none of these are personal either, are they?  Unless you’re human, and then they are.  Oh bother!

Self-Care Tip – Find out what pleases you and what bothers you about your doctor-patient relationships.

Question:  What does please you and what does bother you about your doctor-patient relationships?  How do you imagine it would be if it were even better for your needs?  Please tell us your story.

14 thoughts on “What Makes A Doctor-Patient Relationship

  1. I learned an interesting thing from a woman who is a Lifeline Counsellor here in SA. Her name is Linda, but when she is on Lifeline duty, she calls herself Lindie. When she drives home after a shift, there is a landmark streetlight pole. As she passes the pole, she reverts to being Linda. That is how she copes.

  2. Hi Sana..here in Ontario we have fewer one on one docs except for specialists. It’s groups and you may never get the same one..no continuity. Many new MDs do not want the old family doc role, nurse practitioners see more patients. Personal care exists no more. Oh and for many you can only discuss one problem at a time for billing purposes so if you have a myriad of symptoms that may identify an illness it ain’t goin to happen.

  3. Our family is blessed with an amazing family dr. Our previous dr. retired to work exclusively in the hosp. admin. (darn) and this was my in-laws dr. You practically have to inherit dr.s these days. Which perhaps in its self is a whole other subject.

    Our dr. is very human and down to earth. He made house calls the whole time my father in law was dieing. He lived not far from them and walked to and from work and would just drop by at the end of the day. When Dad died we were told to call him and even if he was off duty we were to let the on call dr. know and he would call. Dr. Mac came with his jeans and leather bomber jacket and his stethoscope around his neck. With this look of amazement as we all stayed with Dad, he apologized to Mom explaining he had to listen for Dad’s heart etc.

    He has been with me as I took my very depressed daughter to him for help, he was loving and compassionate,honest an open, asking her about suicide more than once.

    Our dr. wears sandals and shorts, or jeans, I have never seen him in dress slacks. His dog is in the office and follows him around. Its a little wee thing.

    Our dr. is very human and open and he is very casual and relaxed. He sets a pace for that in the office. Also, you know that when push comes to shove his is 100% in your corner to help you through.

    I have told him things and he has thanked me for sharing with him and let me know I can tell him anything.

    Our previous dr. was amazing as well. He was very pragmatic, very british, and you didn’t always know what was going on in his head. He was thinking and listening to you. If he didn’t know something, for example about prescriptions etc. or whatever, He would say, lets look that up, he would pull down one of his big books and consult. Reminding himself. He is considered an amazing diagnostician and he delivered all three of our children as he was certified for that too.

    Our dr.s different in some ways, were similar in others. They are both caring individuals, calm (especially in the middle of the crap storm that can happen around caring for human beings) They are honest and laugh with you, and have a caring heart.

    I am a fitness teacher, mostly to older adults, and there is a line of professionalism that you keep in place. Chat and visit but some little part is withheld. Or not with held but kept in a separate place.

    Recently someone had told me that their friend had said I was their favorite teacher, and I do hear that from time to time. While we like to hear that we are good at our job (don’t believe your own press good or bad, is what someone taught me years ago and that was damn good advice!) Anyways, out of my mouth came “I can old be as good an instructor as my participants will allow me to be.”

    Where did that come from? But, its the truth. I can only be as good at what I do if they allow me to be. If they are open to receive what I have to share with them. I am a very good instructor and I know that. I feel it deep in my bones and in my Spirit. I know that God has led me to what I am doing. (that’s another whole story!) I can be the straightforward very clinical instructor, but, I can also add an element of spirit and mind, and that is so very important to overall fitness.

    We need to be good patients too when it comes to our dr.s Not always easy as we are frightened, in pain, panicking.

    Not all drs are like the ones I have described. I have heard of many who are not. I guess there are all sorts. I just know that I am incredibly grateful for the ones I have. That includes my counselor I see from time to time over the years. I respect the time and effort they have put in to educate themselves and work their jobs.

    Respect for our health care professionals is fundamental.

  4. In the case of my relationship to my pastoral counselor, I spent most of my time with her wishing that we had met under different circumstances so that we could have been friends and, therefore, would never have ended up in the professional relationship that we were in. Interestingly enough, I have run into her a couple of times since we worked together, and, although we haven’t talked much more than pleasantries, I have wondered why on earth I would have wanted a friendship with her anyway. I think our illness makes us clingy and sets us up for thinking we need what we actually don’t. So, it pleases me that most professionals (I would hope “most”!) set boundaries and don’t allow us to step over them or even develop a hope that we might be able to at some time. It bothers me only in that it was so painful in my case.

    I have written and deleted several times how it would have been if it had been better for my needs – or what would have met my needs better. I guess I don’t know, really. I was in therapy with the same psychologist for about 16 years. Was that too long? Was being with the same therapist all that time a good thing? Was any or all of it necessary? (The answer to that is absolutely some, maybe even most, but all???). Good question. Good one to think about more?!

  5. Something that has helped in “balancing the relationship” with my doctor(s) is I have told them that I possess this body and I am asking their help in maintaining/healing it. But bottom line, it is my body and nobody does anything to it without my consent.

    It may mean that the doctor has to spend more time explaining drugs and procedures than he/she usually does with a patient. If that is not acceptable than it is time for me to find another physician.

    I realize that the medical community is very conscious of legal ramifications in patient care and I am careful to let them know that I take responsibility for my care. If I refuse (or accept) their advise/treatment it is knowing I may be wrong and I will face the consequences without blaming them or bringing legal action against them. I am willing to sign release forms stating this so no one else (family or caring friends) can step in and cause problems.

    My internist met my temper when he told me he did not have time to talk with me! I told him we could talk then or I could make another appointment when he did have more time or perhaps it would be best if we parted ways. Almost 20 years later we are still doctor and (difficult) patient. I always hide a smile when before going to the door he asks if we are through.

  6. Pingback: The Divorce Rate Is So Bad, That…

  7. My doctors (OB/GYN, pediatric, GP) are competent and intelligent people and I genuinely like them. Most of the time, however, it feels as though they are also in a bit of a rush. There are many reasons why this happens, I am sure, and I can understand those factors. I respect efficiency, yet I often feel that the personal connection is missing. Sometimes I feel more like a chart or a set of procedures than as someone they can really see in front of them. I do understand a need for professional distance, but I do think some are better than others at truly connecting. I had an NP for several years who was FABULOUS at striking that balance.

  8. This topic really resonates with me both personally and professionally. Thank you for writing a series of posts on this, Sana. Your main points are both succinct and profound. Distance as strength is a new concept to me which I might interpret more along the lines of distance promoting objectivity in making medical recommendations. Loved Cindy Taylor’s story of Linda.

    Personally, I relate to Bridgesburning Chris King. This post is a little long but makes the point of what is common in large government medical care; how participating in your medical care decisions is perhaps more important than you think:
    http://www.therextras.com/therextras/2009/03/more-important-than-you-thought-.html

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