The Doctor Patient Relationship: Is Informal OK?
How Formal Is Your Doctor?
Should the doctor patient interaction be strictly professional, or is it ok to talk "person to person" sometimes as well?
As a practicing physician, most of the articles I write are based on science. They are designed to relay medical information, mostly about anesthesia -- my specialty -- to people who may be looking for it.
This article is different. This is a topic I have often wondered about. I know how I feel about the topic, but am wondering how others view this issue. How formal should your doctor be in your day to day interactions?
I remember, even in medical school, being uneasy and perplexed by the teaching regarding the doctor patient relationship. Basically, you are taught (at least I was) in medical school that you shouldn't relate personally to your patients. You were to feel and show empathy for them without revealing that you actually had feelings and were never, ever to discuss your personal experiences with them.
I personally thought it was odd, especially with one of patients' major complaints being that physicians seemed "aloof" or "arrogant", but figured the older physicians knew best. So, I played along. The rationale was that you couldn't be an objective observer or clinician if your judgement was clouded by emotion. I get it to a point, but I also think emotional connections (not the inappropriate kind) can help the doctor patient interaction in some ways.
Doctors are People, Obviously
The reason that it never made sense to me is that doctors are people and DO have feelings, personal experiences, whether or not they express them. So, what was really being asked of us was to hide those things.
But, I think that this isn't always the best course of action.
For example, as an anesthesiologist, I take care of people of all ages. I am also a mom of two little boys. One of the hardest things to do as a mom is to hand your child over for surgery. But, I've done it. I have been on both sides of that interaction. My youngest boy had bilateral inguinal hernia surgery when he was 20 months old.
When I sense the unavoidable anxiety of the mom bringing her baby in for surgery, I get it. And, I break convention and tell them so. I tell the parents that I have two kids and that one of them had surgery and I do understand how hard it is to let someone take your baby for what is likely a scary and potentially dangerous (at least that's the fear) procedure. And, I have been thanked for sharing that every single time. Afterwards, the parents say that knowing that made them feel much more comfortable and reassured. I have had no complaints about my being less than formal and related to them on a HUMAN level. I also tell patients that they can call my by my first name if they are more comfortable and ask them if I should use their first name.
I will also let people know if I've had the same surgery that they are facing. I had my thyroid removed, I had a total colectomy (removal of the colon), had in ileostomy (like a colostomy) for a month, had epidurals for my babies… If it seems like it will help the patient to know these things, to help them feel like someone in that operating room "understands" the specific issues and fears related to what they are going through, I will share it with them. It helps them relax and be more positive facing their surgery.
The Doctor Patient Interaction in Anesthesiology
I think some of the things that work for me, work because of the unique considerations of the anesthesiologist.
An anesthesiologist gets about five to ten minutes to meet you, discuss your entire medical history, do an exam, plan your anesthetic and roll you to the operating room. Also, in this time, we like to try to make you feel more relaxed and comfortable. We definitely have drugs that will help you with that! But, hopefully our talk will help, as well.
This limited amount of time does not allow for the building of a working relationship like it would with a doctor that you see regularly in the office. It is for this reason that I think a little personal interaction works in anesthesia.
Limitations and Pitfalls of the Informal Doctor Patient Interaction
This article is not an endorsement of this type of interaction for every doctor patient relationship. It is merely a reflection on why I think it works for me, and may be ok for others in select circumstances. There are, of course, pitfalls and limitations that must be observed
- The focus should always remain on the patient. The doc should not talk so much about themselves that the discussion is derailed from its purpose- to learn about and comfort the patient.
- The doctor must take cues from the patient. As in all of life's interactions, we read cues from those we interact with. Some patients will want to maintain an "arm's length" or more formal interaction. This should be respected. Doctors are providing a service to a sometimes scared and vulnerable (at least in my field) "customer" and should do so, as much as possible, to the patient's preferences.
- Introducing personal feelings and biases should only be done if it will help reassure and comfort the patient. Views of controversial subjects like politics and religion most certainly should NOT be introduced by the doctor or discussed during medical visits. If the patient invites or requests it, each situation should be evaluated carefully.
- Informal does not mean careless or too relaxed. The information revealed by patients in the medical history is still confidential and important. To have a more "human" discussion does not preclude the need to take a careful and thorough history and make sure that the patient understands that their information will be taken seriously and with great care.
How NOT to talk to people...
No matter what type of conversation occurs between a patient and his or her doctor, the physician should always show respect. Even in more informal interactions, the patient should never feel as if the doctor is not listening or caring about what they are saying. Regardless of personal experience, feelings and opinion, the patient's beliefs and wishes must prevail in medical decision making. The doctor should not interfere with this overriding principle of medical care.
But, with that in mind, I am more comfortable having an actual conversation while learning about my patient (keeping the focus on the patient, of course).
How do you feel about this?