Archives for posts with tag: doctor-patient relationship

Less than one month before publication of Talking To Your Doctor! Here’s another trailer with a new take on the importance of doctor-patient communication.

This wouldn’t be so confusing if I had thought about what specialists and general practitioners are each supposed to do. But I have no such a priori understanding. I send a patient to a specialist, and my thought is something like this:

“Gee, I hope they pursue a self-limited course of diagnosis and treatment based on the clinical question I have in mind!”

And the patient, on the other hand, thinks something like:

“Dr. Berger wants Dr. Gutskener to figure out why my belly hurts.”

Dr. Gutskener, on the other hand, possesses a treasure of expertise around the gastrointestinal tract, and doesn’t generally feel his role to be limited in the sense Dr. Berger (me) is thinking of. He takes “limited” to mean “within a given subspecialty” – he does GI, not neurology or cardiology. But within GI, he is taking care of the patient referred to him as best he knows how, and that does not mean a minimal approach.

Graphic by Dave Gray

At some point, telling a specialist not to further test and treat a patient is like Ronald Reagan trying to recall a missile that has already been launched by submarine. But I have had patients where I would like to email the specialist and say, politely, Stop!

I neglected to jot down some notes at the time about Matthew Wynia’s plenary speech at the International Conference on Communication in Healthcare. I think I was too nervous about getting out of the auditorium after the speech in time to overspend at the American Girl store and the Lego outlet. Wynia has a multifarious research portfolio. He has researched the ethical nightmares of medicine during the Holocaust with attention to its implications for today’s practitioners (on which see here). He is also head of ethics at the AMA (the existence of which post, given the AMA’s position until recently on improving access to care for America’s uninsured, gives one some pause).

His talk was a restatement of the aims of professionalism. Starting with the School of Hippocrates, Wynia traced the ethical foundations of medicine – with communication with the patient at its core – to the present day. (I summarized some of his references on my Twitter feed.) While professionalism means different things to different people, Wynia pointed out the etymologic (and to his mind, the true) meaning. To profess means to promise; members of a profession aim to promise something to society; and, thus, professionalism is the means by which a profession ensures that those promises are kept. 

Since the mission of medicine is ethical, professionalism must include ethical standards. The obvious question is how these profession-wide standards are meant to reinforce the relationships that develop in the context of the patient-doctor dyad. Wynia did not address these questions, but he did – in the final part of his talk – emphasize the importance of an institutional culture in making communication (as part of professionalism) possible. I left with many thoughts about how to do this, and – specific to my interests – how best to make autonomy part of initiatives in quality improvement. More to come, I hope, on this effort.