Louisville Medicine Volume 65, Issue 9 | Page 24

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 .
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