Doctors and Patients

I have had some interesting talks these last few days and I am amazed and honored at the openness I have encountered from places I was least expecting it.

The doctor-patient relationship is a bit of an awkward one to describe. I have to back track a bit here and speak of my own medical experiences, but only briefly (and considering I have literally had this crap on my neck, as we German’s like to say). I can say I have had the pleasure of dealing with all sorts.

My very first specialist was a leading body in the Otolaryngological field in the UK (from what I can gather anyway). He preformed the first few laser bronchoscopies on me before I moved back home to Germany.

My next one was the head of ENT at the military hospital in Ulm, Germany. A very nice doctor, I would say mid 50’s. I am convinced I was a challenge that in the end he had no choice but to admit defeat after the cricoid plastic did not improve my laryngeal health. The only ‘negative’ I would mention here is the fact that after the cricoid plastic it took a bit of convincing that my symptoms had not improved and were deteriorating rapidly, and not just because I had ‘unlearned how to breath properly‘. However I was always able to contact him or his office when I had questions and I am pretty sure I could still do.

I was referred to Heidelberg, Germany where I was to spend the next seven years of my clinical life. I can tell you I ended up being quite popular amongst the staff. They always stuck me into a room with new patients so that I could explain how it worked and save them doing it. Here I was looked after by a team of ENT specialists, basically because I was such a fascinatingly complex case (slicers and dicers, eh…. go figure) They were gutted when it was obvious that the resection they carried out hadn’t worked (according to one of them I was their first patient where it proved unsuccessful).

Back in the UK I naturally visited my old ENT specialist to try and move my treatment from Germany to here (I think it goes without saying that it is logistically easier considering I live here now). After two visits I was again passed on to another ENT specialist (God, I feel like some exotic creature)

Anyway, with all these medical excursions I have noticed on thing (and funnily enough it has only just really occurred to me a few days ago): doctors, particularly leading specialists carry about them a certain kind of arrogance. And it is difficult to pinpoint what kind of arrogance it exactly is. It is different with each one. Some seem more approachable than others. But they all have one thing in common: As much as they try to show empathy, they are completely detached from things, cases, people. The majority of times they have to be. You cannot allow yourself to make cases personal. You would not be able to stay sane being a clinician if you connect with each and every patient you deal with emotionally.

I am a clinician myself, if only a gum gardener, but I have to say, I find myself in that trap sometimes. From a patients’ perspective though it can be quite frightening, perhaps even a bit belittling. I am also a patient, so I can see it from both sides, try to at least. Perhaps that is a big advantage for me in all of this. As clinicians we very often tend to forget that anything we explain to a patient, a person sitting in front of us, for us is routine. We know the theory, the practice, we do procedures constantly. We know the in’s and out’s in it, so we tend to get very matter-of-fact and to the point. That may give off this air of arrogance at times. But it isn’t. It’s just too much routine in our working day. We forget that for any patient it is probably one of the first times they have had whatever done.

Can you remember what you were like as a child going to the doctor or dentist? Those of you with children are in the midst of it, just like me. Seeing that with my son, how terrified he is when he experiences things for the very first time takes away this detachment a bit.

Without wanting to encourage patronisation, I think it would help a bit if doctors would try to see patients of any age as ‘children’ (or perhaps novices is a better word), vulnerable and frightened, rather than blurting out things like ‘we give you about a year to live‘ (thankfully that one proved wrong and no it wasn’t me!) or speaking to a colleague, saying in front of an expectant mother ‘so, what other risks apart from spontaneous abortion are there?’

For children, we take the time to be empathetic. To explain. To consider and ask about feelings. Why not for adults? I think we kind of, without admitting it, would love to be a bit like that child again. It would, perhaps take the fear and dauntingness away a bit, which would be so vital and comforting in a lot of chronic and complex cases.

 

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