Returning to the Sacred Patient/Physician Relationship

Image: VILevi/shutterstock.com

Seeing physician burnout articles every page you swipe on social media, on physician online media groups, and in editorials of national syndicates is becoming the norm. It can become fairly discouraging reading about the fate of well-educated healers with only the noblest intentions becoming victims of the healthcare climate that is medicine today. Reading about these issues, you can become disengaged when in the throes of working. It is when you become completely removed from the situation when you realize the extent of the dysfunctional system.

Yes, the system is terrible, yes, there are too many regulations, too many middlemen, too many people getting in the way of the genuine whole-hearted connection between patient and physician. Where does that leave us and how can we rectify the situation?

Patient/Physician: The Sacred Relationship

It used to be that the relationship was between patient and physician. There was no such thing as health insurances, no such thing as MOC, no such thing as EMR, no such thing as healthcare professionals. It was patient and physician. Physician and patient. Doctor and patient. Patient and doctor.

There was nothing to separate the physician from caring for his patients. Doctors used to travel with their doctor’s bags to their patient’s home, making house calls, being paid with services or what little the family had on their farms. Doctors took out their trusty stethoscopes and gave a healing balm; sometimes they helped their patients, sometimes not, since the remedy was beyond the technology at the time. There was no such thing as malpractice insurance. No such thing as deductibles, no such thing as premiums, no such thing as clicking little boxes that sum up a human’s suffering. The relationship between a doctor and his patient was at its best and humblest — to care for the sick. Not to cure, not to treat, but to comfort always. Absolutely nothing stood in the way between doctor and patient. That relationship was pure and untouched.

Going Back to Your Roots

How does one go back to this very sacred traditional relationship? If doctors do not realize this is a crisis situation where this very symbolic connection is being threatened by a huge number of many outside forces, they must be hiding under a rock. When you see hundreds of articles on physician burnout, how to end the patient interview, courses on coding to get the most out of a visit, you know there is something utterly amiss with the system. There will be the business end of the situation — you do have to pay for staff salaries, paper supplies, etc. after all. But the physician-patient relationship is one of the most paramount human connections that cannot, and should not, be replaced.

To heal and to comfort someone during their last few days, to determine if someone no longer has meaningful recovery after suffering from a massive myocardial infarct, to tell a patient they have a glioblastoma multiforme and there is very little chance of recovery — these are sensitive dealings that should not lay on artificial intelligence, a medical substitute, or paramedical person.

Important discussions like these should be with the physician.

In order to have these important discussions, one must first have a relationship. One must never forget why we have entered medicine, to serve our patients. The human connection between a patient and physician is one of trust and hope. But how do we get back there when there are so many compelling factors threatening its very existence?

Acknowledge There Is a Problem

A basic tenet of remedying a situation is to acknowledge that there is a problem. When you realize the way you operate is not sustainable, your psyche will address the situation and make changes. If you stay in limbo, the system can consume you and spit you out. Such are the sad cases of colleagues ruthlessly cut to be replaced with cheap labor by the upper business echelons. Difficulties coping with this new, unsatisfying, overburdensome system leads to disillusionment. Physicians who took pride in their work are now reduced to electric circuits, and some take their own lives.

Get rid of the middleman.

I used to have a wonderful medical assistant. She did all the pre-questionnaires for me and dutifully entered it into the computer database. As the patient entered my office, I am guilty of saying, “Hold on, let me read what my assistant typed,” while the patient sat, gob-smacked, looking at me silently. Looking back, I can only shake my head and wonder, “Wow, what was I thinking? I sounded like a cold robot,” which I was.

All the boxes were checked perfectly, I did my neurological exam, whipped out my pad, scribbling five medications for five different symptoms, filled out MRI forms, went over the plan speaking as quickly as possible. Off my patient went on his merry old way, disillusioned and somehow left unfulfilled. Imagine this occurring 20 times a day. I was fried by the end of the day, my patients left dissatisfied, and staff went through the office like hotel guests through revolving doors. When I used to work in hospitals, residents did the pre-work-up, as was part of their training. Relationships were fleeting; care was in teams and rotations.

Now, I see new patients for one hour. They are eloquent. They are unique stories again, not templates that you copy and paste and change with a few details according to the patient. I let them expound until they have nothing left to say. I ask my part, perform my examination (provide the healing touch that every patient subconsciously craves), and we go over the plan. I answer all questions until there are no more.

It is not uncommon for a patient to shake my hand, look me in the eye, and thank me. Other times, I receive a warm hug. It is not just as a courtesy gesture but a real expression of appreciation. While I did not cure them, I provided so much more — the therapeutic healing relationship that exists between a patient and a doctor that no matter what happens I am now there for them. My heart warms and I modestly reply that I didn’t do anything.

But, deep down, I can feel the palpable difference.

I have returned to the roots of medicine. I finally understand that this is what it is all about. I now listen to them. I listen to their own unique stories. I make eye contact and take in everything they have to say, the furrowing of their brows, the tone of their voices, and I hear what they are saying. I now get comments how they are happy they found me , that their last doctor only took five minutes. I muse to myself, I used to be that doctor. I remain neutral and non-judgemental, but I am now aware there is a simply better way of practicing now.

How to Get It Back

Go back to the basics of communication and human connection. That’s probably the reason why you entered medicine. We are slowly replaced by parallel industries where practitioners of dubious training are hailed new miracle healers. Everybody is calling themselves doctors. They spend more time listening and are less regulated. We have lost the art of listening. It has gotten lost in the world of electronic recording, the need to generate copious amounts of data on one patient encounter, in the new team service approach.

The unique relationship between doctor and patient is subsequently insidiously altered — soon to be extinct as doctors are slowly being replaced and encroached by other forces. But the solution is very simple: we must return to the country doctor model. Listening provides great comfort. When comfort is achieved, we have done our job. We may not cure or treat, but we always comfort. The paradigm shifts back to doctor and patient.

One more time, cut out the middleman.

I cannot emphasize it enough, cut out the middleman. Anything that keeps you apart from your patient widens the chasm and becomes a barrier, an impediment. Assistants, insurances, computers, physician extenders; these were never around before. When you strip it back down to the bare bones, you return to the rawest, purest form of medicine — the relationship between doctor and patient. Patient and doctor. It is only then you will realize the depth that is medicine. Only then can we practice medicine the way it is supposed to be…between physician and patient. Patient and physician.

Dr. Virginia Thornley is a Board-Certified Neurologist sub-specializing in Epilepsy and Clinical Neurophysiology in private practice. You can follow her on @VThornleyMD. To read more of her writings, visit https://neurologybuzz.com/

More from Op-Med