286 Interacting with Their Patients
preventive care’’ for adults:‘‘ getting on an exercise program, worrying about your bones if you’ re on steroids.... Doctors weren’ t thinking about it.’’
‘‘ I’ ve Become Like a Social Worker’’: Nonmedical Aspects of Care
Ill doctors became more sensitive to nonmedical aspects of care as well. Many came to address more regularly and thoroughly questions of whether patients could afford medications, and had transportation home, and adequate home care. Ronald, the suburban radiologist, said,‘‘ I’ ve become like a social worker’’— highlighting the degree to which physicians ordinarily saw such duties as outside their role. Many of these physicians had overlooked nonmedical aspects of patients’ lives( e. g., applying to Social Security for disability benefits), and now extended the scope of their responsibilities.
Some ill physicians now addressed more than before psychotherapeutic issues( e. g., having patients develop and work toward‘‘ life goals’’). Deborah, the psychiatrist with breast cancer, came to make sure patients had aspirations for themselves and future plans. In doing so, she felt she deviated from traditional doctoring. As a result of her own illness, she urged patients more regarding not only establishing, but also achieving, personal goals.
Previously, I’ d help them do this and that, but now I push them. Sometimes I think I’ m crazy about it. Before, I would have said,‘‘ Do whatever you want.’’ But now people come back and tell me what they’ ve done. Somehow, my system works.
The narrowness of the biomedical model, and competing time pressures, inhibit physicians from ordinarily addressing such issues with their patients. Yet patients may benefit from physician interest in treating the‘‘ whole’’ person in these ways. Appropriate training in these approaches would clearly be helpful. In these ways, physician hierarchy could further be used to good ends.
Physician Assistants have more time than physicians, and could provide services for which the latter have inadequate time. Patient advocates could help, too. Sally, the internist with cancer, suggested that tertiary care doctors in particular hire more nurse practitioners‘‘ to do the things other than fighting the fires.’’