‘‘ Screw-ups’’ 113
In social interactions more broadly, each party generally wants the other to feel positively, and doctor-patient interactions are no exception. Jacob, the religious radiologist, described how he wanted to bolster his physician’ s feelings. However, as a result, he avoided asking many questions.
I know that the doctor feels good if I trust him. The fewer questions I ask, and the more he knows that I feel I’ m in his hands, the happier he is, and the more positively he’ ll relate to me. I want him to know he’ s a good guy.
Dependent, and eager for as much assistance from their doctors as possible, even these ill physicians felt they needed to engage, and at times flatter.
This process of approval-seeking may take hold after an initial period, during which time trust in the doctor is established. Jacob continued,‘‘ I’ ll look for dents in the armor of his abilities, in which case I might switch providers.’’ But once Jacob decided to work with a particular doctor, he remained, and tried to establish as strong a relationship as possible.
In turn, doctors provided feedback that encouraged patients’ efforts to please. Patients may then realize and get‘‘ conditioned’’ that their doctors seek positive feedback. Lou, the cancer patient who had a plaque on his wall, elaborated:
Patients protect doctors. When the doctor stops on rounds, and says,‘‘ How are you doing?’’ and the patient answers,‘‘ Poorly,’’ the doctor has a long-drawn face. When the patient says,‘‘ Fine,’’ the doctor smiles and waves hello. The patient gets conditioned. The question is, Who’ s protecting whom? And how do we get around that?
Lou suggested that physicians protect themselves partly from difficult interpersonal or potential medical issues with patients. He felt that in these interchanges, he and many patients implicitly sought to deny their illness.
Patients sought opening cues from doctors that affirmed the possibility of raising certain topics; conversely, the absence of such cues can impair communication. Stuart, the internist with HIV who was now teaching at the university, described how even hugging patients could unintentionally silence them.‘‘ I tend to be a hugger. But I realized that sometimes when I’ m hugging people, I’ m really giving them physical cues to shut up! So I tend now just to hold their hand or touch them.’’