The Doctor/Patient Relationship

Hippocrates wrote:  “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” 

Part science and part art, the practice of medicine has changed drastically in the six thousand years since Hippocrates first uttered his famous oath.  This evolution in recent decades, as seen both in its practice by physicians and the expectations thrust upon it by patients, has influenced a shift away from the hands-on study of the body as a primary means of diagnosis to a more clinical approach, due to both the advances of modern medical technology and the wealth of health care related data accessible to all via the Internet.

A Little History

Thousands of years ago, medicine offered little more than diagnosis and prognosis.  The doctor’s role was not to heal, but to predict.  Over time, advances in both the understanding of human anatomy and the power of medical technology combined to revolutionize the medical expert’s ability to identify and treat a variety of illnesses.   As physicians learned more about the interplay between each of the body’s organs, scientific discoveries began to shed new light on the mysteries hidden beneath the skin.  The physician’s exam, once lauded as the cornerstone of diagnostic science, gave rise to the X-Ray, which led to the CT scan, to be followed by magnetic resonance imaging (MRI).  In truth, such technological breakthroughs are the reason so many diseases once considered death sentences are now routine and treatable.

There is no question that these modern scientific marvels have greatly increased the twenty-first century physician’s ability to diagnose and treat his or her patients.  But there is a cost. Initially intended as practical tools to gather additional data upon which to base a diagnosis, these new tests and procedures have become the central focus for many medical practitioners who largely ignore the bounty of information to be found in the appearance and functioning of a patient’s eyes, skin, teeth, hair, and reflexes. The art of the physical examination, once so essential to both the diagnostic process and the emotional well being of the patient, is becoming obsolete.

What Television and the Movies Can Teach Us About Medicine

These improvements in modern technology are in large part responsible for the transition that has taken place in the modern doctor’s bedside manner and overall attitude toward the patient.  Nowhere is this trend more apparent than in the changing role of television doctors throughout recent decades. In the seventies, for example, Robert Young portrayed the kindly and world-wise general practitioner Marcus Welby, M.D., a man who struggled to treat his patients with compassion in a profession trending steadily toward specialized, impersonal care.

Such struggles were in vain, it seems, as Welby’s contemporary counterpart, Gregory House, M.D., uses his diagnostic brilliance as a means to keep himself always at arm’s length from his patients.  No longer is a doctor thought of as a kindly old man who makes house calls and listens to his patients’ troubles and aches, he is now instead a young physician who hardly handles his patients while computing a checklist of ailments from which to order the proper panel of tests.

While the discussion of Drs. Welby and House above may portray two extremes in the doctor-patient relationship, the range of combinations in between has also appeared in television and film alike.  In The Exorcist, Chris McNeil is a very concerned mother who desperately wants to identify the medical condition responsible for altering the behavior of her daughter Regan. The treating physician, relying upon early 1970s medical technology, offers his explanation:

“It’s a symptom of a type of disturbance in the chemical-electrical activity of the brain.  In the case of your daughter in the temporal lobe, up here in the lateral part of the brain. It’s rare, but it does cause bizarre hallucinations.”

Late in the film, Regan’s physician returns to the McNeil Household during one of Regan’s more memorable performances.  Though scientifically baffled, the physician is determined to hold firm to his instincts:

“Pathological states can induce abnormal strength, accelerated motor performance. For example, a ninety-pound woman sees her child pinned under the wheel of a truck, runs out and lifts the wheels half a foot up off the ground. You know the story, same thing here.”

With no knowledge of the reasons for her daughter’s illness, Regan’s mother, like most people, was unable to engage in any meaningful debate about the accuracy of her daughter’s diagnosis.  Armed with years of medical education and training, the ordinary doctor circa 1973 could strong arm just about anyone with his opinion.  All this has changed, however, with the advent of websites such as WebMD, MedicineNet, and WrongDiagnosis.com.

The rise of the Internet has made advances in medical science more accessible to patients, granting them new depth and scope, medically speaking.  With such a wealth of knowledge literally at their fingertips, patients now want information immediately when it relates to the science of medicine, often researching both disease and cure on their own.  For better or worse, doctors have to some degree lost the unquestioned sanctity that has historically accompanied their “mysterious” profession.

Rebuilding the Doctor-Patient Relationship

Though the benefits of modern technology are not to be overlooked, the changes they have instilled make it increasingly important for both medical practitioners and their patients to maintain an objective approach to one another.  A well-rounded doctor would do well to incorporate newfound scientific resources with renewed emphasis on the physical exam and patient history, in an effort to once again personalize the medical experience.  A wise patient must keep in mind that the Internet, while a practical educational tool, is no substitute for a medical degree and in-field experience.

Perhaps most important to improving the doctor-patient relationship is the need for communication.  To get the most out of your doctor’s visit, it is essential that you express yourself while at the same time understanding the often complex issues and instructions your physician presents to you.  Following is a set of guidelines to assist patients in their effort to communicate quickly and effectively, so that doctors have the information necessary to do their job and patients feel their needs have been addressed:

−  Be thorough.   Your role is to provide the details on how you are feeling.  The doctor will decide what is relevant.

−  Be honest.  Your doctor has seen it all, and he or she is not there to judge you, but to heal you.  Telling the truth about lifestyle choices, symptoms, and concerns marks the fastest route on the road to recovery.

−  Ask questions.  If something your doctor says about your condition or treatment is unclear, ask him or her to repeat it or put it in simpler terms.

−  Bring lists. The better prepared you are for your visit, the more relaxed you will be when questioned, and the more you will benefit from your doctor’s instruction.

With all the benefits provided by modern medical technology, it is clear that the clinical emphasis on diagnostic medicine is here to stay.  As the relationship between physicians and their patients continues to shift, it is important for both sides to remember that the practice of health care is a partnership as well as a profession.   By effectively opening up a dialogue in which information and concerns can be shared, the doctor is better able to assess the situation, while the patient is made to take a more active role in the course of treatment, leading to a more relaxed, balanced and satisfying experience for all involved.

Craig Boyd Garner Bio

Craig is an attorney and health care consultant, specializing in issues surrounding modern American health care.

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