Thursday, January 19, 2006

American Medical News article on "relationships" leaves retired doc confused

The Jan 16, 2005 issue of American Medical News (subscription required) features a frontpage article on what they describe as the new buzzword in medical care "relationship". A special supplemental issue of the Journal of General Internal Medicine is devoted to that topic.The references to what this movement is about in the AMNews article left me uneasy. I could not get my mind around what was being said.One quote:" At its core, relationship-centered care calls on physicians and patients to have longstanding compassion relationships with each other." So, we or someone is to call on patients to have compassion for the doctor? Our job is to take of the patient, to place the patient first, to have a fiduciary relationship with the patient. Physicians may well have compassion for their patient, we typically do empathize with patients. What would generate compassion for the physician? Typically we are well paid,enjoy a generally prestigious status in the human food chain, are in a position of knowledge superiority in the patient's medical condition .The fact we work hard and often really seem to care-and often do care-make well cause the patient to feel a variety of emotions toward the doctor: gratitude, resentment (the doctor is is not sick),faith in her ability, relief of being told nothing serious is wrong, hope that the physician's reassurance is correct, and many others but compassion does not seem one of them. Quite frankly , I have trouble deciphering what is meant or hoped to be accomplished by comments like "moving away from the customer comes first and into something more focused on producing a fruitful, robust relationship." I would like to know what that "something" is and what will be the focus and I always though the "customer" formerly known as patient did come first. The editor of the special issue of the general medicine journal is quoted as saying " this is not just sitting around and holding hands and singing 'Kumbaya"...
But,knowing only what is in the AMNEWS report and observing doctors and patients for 40 years and while realizing that a good relationship is important, until I can learn more specifics about what it is they are advocating it does seem like hand holding and singing.Hopefully one of the handful of readers of this blog who have a better handle on this movement can help me understand it and it may well be that the news article did not do justice to what these folks are advocating.

2 comments:

Moof said...

Actually Dr. Gaulte, compassion for the physician is not such a bad idea.

The beginning of such a relationship could include a realization on the patients' part that doctors are human, feel fatigue, make mistakes, have their own likes and dislikes ... bad days ... family concerns ... etc. ...

I can't think of another profession that has an unwritten (but tacitly enforced) rule that prohibits the practioner from having human qualities, needs ... problems ... in short, himself partaking of the human condition.

Patients who see their physicians as collaborators toward the goal of making them well (or keeping them that way) are more likely to hold up their own end of the bargain, too - rather than expecting miracles from their medical care while they cheat on their diets, don't exercise, and don't take their medicine as prescribed.

Now, I'm not sure what those who wrote the article meant, but I think there could be some patient education in that area ...

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james gaulte said...

I agree compassion for the patient may well be a good thing.It would be probably good for both the patient and the doctor.However, I do not think that physicians can educate the patient along those lines.And as so many folks have pointed out, the managed care mess has severly strained the positive elements of the doctor-patient relationship.