FEATURE
even of having ulterior motives within their practice of medicine. These misperceptions are particularly frustrating to me considering the amount of preparation I routinely do. This was especially apparent when a patient angrily accused me of not listening to him after I failed to expand on every detail of the issues he felt most important, specifically, how his insurance company was corrupt( we know) and how his extensive list of previous medication trials had failed. He discovered my presentation of his case omitted these findings when I returned with my attending, after devising a new treatment plan which began with reviewing what had already been attempted. When he told me I should feel stupid and ashamed, and criticized the way I held my face, gusts of shock and emotion, much like that harsh winter wind, came over me unexpectedly. The comfort I had previously felt as an outpatient physician quickly unraveled as this patient’ s unexpected mistrust and paranoia cooled the room.
Just moments before, I was finding my niche as an outpatient provider and happily connecting with patients in what I considered a pleasant turning point within the novel of medical career. Then out of nowhere, the book slammed shut, causing a startling noise and leaving debris behind, no wonder or happiness for medicine to be left intact. I tried to maintain my composure and confidence, think of the“ doctorly” thing to say, but I just couldn’ t this time. I excused myself after a few tear drops escaped and left the room to go to another unused office where the floodgates burst open.
While this is a harsh example of a disconnected patient-physician interaction and one that stands out due to being atypical, it illustrates how frustrated and unheard the patient felt by his medical team. Here he was trying to convey all the years of hardship he experienced with his condition, the failed medication trials, and his sense of helplessness and hopelessness. He did so because he thought it would prove why he needed different and better treatment. However, it also illustrates how much the physician felt misunderstood by the patient; I felt disappointed with his course as well and agreed that something different had to be done. Let’ s be real: physicians want to be understood just as much as their patients want to be. In fact, it is vital to good care. So how come it feels like no one’ s listening on either side? Somewhere along the way, amidst sensationalist headlines, insurance domination, and the plethora of pseudoscience readily available on the internet, patients have lost trust in their physicians.
" Forgiveness on both parts is our only real hope that the harsh winter’ s wind will pass and some sign of spring will appear."
When I first got out of medical school, I never imagined that I would have to convince patients that I knew what I was talking about before ever addressing the reason they came to the office in the first place. I thought that completing medical school would speak for itself, but the amount of skepticism that patients present with in regards to their medical providers is truly astounding. Sometimes I feel like a used-car salesman trying to win patients over with examples of how well other patients have done with such and such treatment. It feels like an uphill battle some days. I could go on and on about the evidence and studies behind their recommended course of care and lose them in the heap of medical jargon I would inevitably throw around, or keep that to a minimum and risk them believing something political or moral was driving what I was prescribing. The fact of the matter is that medical decision-making is becoming more and more complicated, whether it should be or not, and it is even more difficult to communicate this process to patients, sometimes even more so if they have a medical background or are connected with the medical community in some way, already in possession of a bias. This situation creates a barrier to physicians being understood, but it is just one of many. Medical decision-making as a concept needs to be introduced to society it seems, but more importantly, patients need to understand that it is driven by the meticulous nature of providers who truly care about them.
So, how do we convince them that we care? Maybe the conversation could start with something like,“ First, I want you to know I am on your team.” Ah, yes, direct communication is often the first tip given to two parties looking to mend a broken relationship. Aside from that, the answer is forgiveness. We hope that patients will leave behind atrocities committed by physicians who have nothing to do with us, realize we are not their insurance carrier, and take with a grain of salt the information they may have acquired before stepping into our offices. Likewise, may we forgive them for misunderstanding us. Just as we don’ t presume to know everything about them, they don’ t presume to know everything about us. Forgiveness on both parts is our only real hope that the harsh winter’ s wind will pass and some sign of spring will appear.
Dr. Kara Curry is currently a child and adolescent psychiatry fellow at Tufts Medical Center. She moved to Boston, MA after completing adult psychiatry residency here in Louisville.
22 LOUISVILLE MEDICINE