Wednesday, March 21, 2012

The Doctor-Patient Relationship Can Be Difficult

I walked down the hospital corridor listlessly. My feet dragged as they fought each attempt to lift off the ground. My body was tired and achy. The phone calls the night before had been relentless. Each stolen moment of sleep was interrupted before a deep, restful state was reached. It was Monday morning.

I sat at the nursing station flipping through charts. A colleague across the table was staring intently at his computer screen. He previously had been a private practitioner like myself, but he shuttered his practice to become a hospitalist. He glanced over at me appraisingly, taking in my disheveled hair and unshaven face.

Hard night?

I nodded in his direction, and looked up from the progress note I was struggling to complete. I wasn't making much headway.

So why did you leave your practice anyway?

A look of pity came over his face as he stared down at a coffee stain on my wrinkled gray lab coat.

I was tired!

He went on to explain that it was not physical but rather emotional fatigue that spurred his decision. He was tired of fighting with his patients.


As I exited the hospital and walked a few hundred feet to my building, I pondered my patient interactions over the the last week.

A healthy thirty five year old woman called my office daily for a benign upper respiratory tract infection. During each conversation she demanded an antibiotic, and each time I explained how it was inappropriate. I cited studies, explained the possible harm to herself as well as society, and gave a number of recommendations for alleviating symptoms. She responded by saying that all her friends doctors gave them antibiotics. Eventually she decided to leave my practice and find care elsewhere.

A hundred year old demented woman was placed in a nursing home after a devastating stroke which left her completely unconscious. Her previous doctor had dutifully ordered a feeding tube and transferred her to the nursing home for further care. Last week her kidneys began to fail, and her son demanded that we initiate hemodialysis. I invited the family to the nursing home and spent an hour discussing futile care and it's consequences. We talked about how hundred year olds don't tolerate dialysis well, and that her quality of life was already low. After becoming very emotional, the son stormed out of the room and accused me of trying to kill his mother.

A 60 year old woman with chronic back pain came to my office for a refill of a narcotic prescribed by her orthopaedist. I talked to her about the pain ad nauseum, and described how narcotics are not affective for long term control of musculoskeletal pain. I looked her up on the Illinois prescription monitor, and my eyes popped as I calculated that she received over 250 hydrocodone pills from three different doctors over the last week. When I refused to write another, she stormed out of the office and threatened to call the local medical board.


The doctor-patient relationship can be difficult. At it's best, it is a mutual, symbiotic connection between client and consultant. Sometimes, however, being a physician is like trying to parent two thousand teenagers. Although there is great affection on both sides of the examining table, the perspective is markedly different.

I admit that I can never know exactly what my patients are feeling, I haven't walked a day in their shoes. On the other hand, I have years of experience treating just the sort of complaints they come to my door seeking help with.

There are days when I fervently wish they would let me use this experience to help them.

And there are days when I wonder if I should have ever decided become a parent in the first place.


Alexandra Yperifanos said...

Wow. I love the humanity of this article. Beautifully and thoughtfully written. Thank you.

AfternoonNapper said...

Why did you become a parent? Because you care enough to even ask that question and to be frustrated by patients and situations such as those you've mentioned. It would be inordinately easier not to care; however, caring is what gives someone depth.

I gave a pep-talk along these lines to another doctor just yesterday - sometimes doctors get yelled at because there is no one else at whom patients can yell. You are the personification of their frustration and loss and anger. Sometimes you have to let them be mad at you realize that it's not really you at whom they are mad. It would be huge if you could help them work through their anger. Sometimes we don't want an explanation as much as we want someone to say, "I know this has got to be frustrating as hell" or "I'm sorry you're in this situation." Put the pen and chart down. Take a seat. Make eye contact. Listen. Ask questions that don't simply have yes/no answers. Even if you spend just two minutes more with a patient doing these things, it helps the patient feel involved, cared for, and cared about.