Doctors, Your Patients Are Human Beings

http://silenciorn.deviantart.com/art/Stethoscope-279190421I’ve seen a lot of doctors in the past three years – too many to count on my own two hands.  The number of doctors by whom I felt heard and truly cared for, though, is less than a handful.

Maybe my expectations are too high, but after running the gamut of doctors, I’ve come to believe that a doctor’s responsibility runs much deeper than simply diagnosing a physical complaint and running a treatment protocol. That’s because when we go to a doctor, we go not just as a bundle of body parts and malfunctioning cells sitting in an isolated exam room. We go as living human beings connected to families, communities, religious traditions, and a reality beyond the material.

All too often, doctors seem to miss this reality. Admittedly, we aren’t going to them to get our souls treated; doctors are tasked with treating our bodies. But then again, bodies are much more than anatomical parts and processes. Furthermore, western medicine is not the end-all-be-all authority on diagnosing what’s going on in our bodies. Reading physical symptoms, taking medical images, and running tests only reveal a partial truth. The truth of what the patient is experiencing, in my opinion, is just as weighty.

Melanie Thernstrom, in her book The Pain Chronicles, describes that in recent centuries, the question that doctors ask their patients has shifted from “What happened?” to “Where does it hurt?” It’s a subtle shift, but one that reveals a dramatic reorientation of perspective. No longer is the doctor asking the patient to tell their story about how they’ve ended up in the exam room, with all its starts, stops, hesitations, and implied meanings. Doctors now completely bypass patient understandings and instead hone in on the physical problem, minus patient narrative.

My own countless doctors’ visits attest to this fact. I would go into the exam room prepared to explain to the doctor when my ankle pain started, how I think it started, what I’ve tried to do for self-care, and my questions. Oftentimes, before I got a chance to get out more than a few sentences, the doctor would jump in. “Okay, take off your shoes and socks. Does this hurt? Can you rotate your ankle this way? Resist when I try to push your foot this way. Okay, now get up and try to stand on your toes. Hm…okay, take two ibuprofen three times a day for two weeks and it should be fine.” Before I could re-gather myself to ask questions, the doctor would be gone.

This description is only a slight exaggeration of my experiences. In short, the treatment of many doctors has left me feeling voiceless, like an inanimate object squeezed into a too-short time slot, cursorily poked at, and then ejected from the exam room right in time for the next inanimate object to arrive, and not a minute over.

My friend in her second year of medical school pointed out to me that a lot of the problem is the whole health care system in the United States. Unless they run their own practice, doctors don’t have a lot of say over how much time they are allotted to spend with each patient, and they are required to see a certain amount of patients a day in order to satisfy the group or hospital requirements. The system of which doctors are a part, willingly or not, simply doesn’t give them much wiggle room to take a more personal approach. I agree. I think the system needs to change.

Beyond the logistics of the system, however, lies a deeper issue of epistemology – that is, how knowledge is arrived at. Western medicine has evolved such that knowledge is believed to lie in concrete physical facts which can be measured, compared, quantified. Pain is rated on a scale of 1-10. (I’ve always disliked having to reduce my experience of pain to a number.) To be sure, numbers are helpful, and without such cut and dried measurements and processes, we might still be getting bled and leeched every time we saw the doctor.

The problem with numbers and cold measurements, though, is that human experience often gets cast to the wayside. How has the stroke affected Mrs. Farhad’s life? Does she see it as an act of God, something that she should resign herself to, or as a result of diet and lifestyle, something that she can gradually improve upon?

What patients themselves make of their ailments matters, not just for treatment, but also because how they interpret their experience through the matrix of their own cultural and metaphysical understandings of the world is a kind of truth. It is the truth of their everyday existence, of how they live their lives. Even if it is not the lens a medical professional uses to diagnose and treat maladies, this does not mean that it is irrelevant.

What am I asking for, then? I am asking that doctors listen to their patients. Not just listen to the number at which they rate their pain, but listen for what their pain means to them, how it has changed their lives, what it does to their sense of self. I am asking that doctors step down from their pedestals of lofty, scientific training and approach their patients in a collaborative eye-to-eye relationship. I am also asking them to take into account different kinds of knowledge – personal experiential knowledge and not just abstract textbook knowledge. Bottom line, I am asking that doctors treat their patients as human beings whose voices matter.

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6 Comments (+add yours?)

  1. Matthew Loftus
    Mar 11, 2013 @ 17:03:05

    A few thoughts:

    1. I agree completely! The pressures of the medical-industrial complex and the professionalization/scientification of the practice have pushed people towards colder practice.

    2. The pain score is complete nonsense. It is used by nurses to tell if pain medicine is helping and by administrators who never touch a patient to see “if we’re controlling pain.”

    3. This is why primary care is so important (and why we should be working harder to make sure that we are training good, caring holistic primary care physicians.)

    4. It is highly likely, given your complaint, that many of the doctors that you saw were orthopedic surgeons. They are not exactly known for being warm & fuzzy (they are kind of the meathead jocks of the medical world.) See this video: http://www.youtube.com/watch?v=3rTsvb2ef5k

    Reply

    • Liuan
      Mar 11, 2013 @ 21:52:44

      Appreciate your thoughts, Matthew, as a doctor yourself. I agree with you that better training (and maybe better compensation?) for primary care physicians, and more of them, is so important. And yes, some of my most negative doctor experiences have been with orthopedic surgeons, interestingly enough. Although, I am still seeing one podiatrist (does he count as an orthopedic surgeon?) who does not fit this mold at all. He runs his own practice and actually answers phone calls, amazingly! Thanks for sharing the video link.

      Reply

  2. Pam
    Mar 11, 2013 @ 17:59:57

    Yes…Western Medicine has split the person into parts: Body, Soul, Spirit–instead of viewing people as unified wholes. So–doctors are for the body, psychotherapists are for the soul, and pastors/priests are for the spirit. This “splitting” has enabled focused exploration, but has not taken the whole person into awareness. This is like fixing a transmission on a car without putting fuel in the tank–it still won’t go. So…makes us wonder what to do…
    As a side note, insurance companies are now trying to limit the amount of time counselors spend with people too! The new billing codes for 2013 have sessions broken into 30, 45, and 60 minutes. My sessions have always been 60 minutes…can’t imagine trying to do good depth work in 30 or 45….bad idea in my opinion….

    Reply

  3. Liuan
    Mar 12, 2013 @ 03:01:41

    A friend shared with me this TED talk called “A Doctor’s Touch” that really speaks to what I’m trying to get at in this post: http://www.youtube.com/watch?v=sxnlvwprf_c

    Reply

  4. Trackback: Heal Me—Body, Mind, and Soul | The Chronicles

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