Can a professional physician be indifferent to patients?

What does it take for a medical professional to express at least the same level of empathy to patients we are accustomed to receive in a civilized environment? And consequently what do patients perceive as a good quality care?

Looking at many comments on the subject published by medical professionals, one can identify at least three modes of thinking:

 

PatienSat
1.Patient satisfaction depends on physician’s workload.

2.Give patients what they want to make them happy

3.The doctor knows better.

 

With respect to all the opinions, how do patients and family caregivers fit to this triad?

 

Patient satisfaction depends on physicians’ workload.

One of the widely spread complains often heard in medical environment is that about the lack of personnel which causes fatigue leading to lower quality care. Looking at such arguments from a patient perspective, one starts wondering: if this is so, why almost every day a new doctor is visiting a patient asking the same set of questions? It is not a rarity that a patient is visited by three or four doctors a day each of them repeating the same standard questions: age, weight and the reason for hospitalization. Then all of them are promptly leaving. No wonder that up to 90 percent of patients are unable to correctly name their treating physician. If for a physician a patient is an anonymous bunch of organs and problems, a physician for a patients turns into the bunch of functions.

But there can be exceptions. The name of the doctor the patients from Endocrinology Department of Krankenhaus (hospital) Schwabing will remember is Dr. M. Walter. Not because he had a habit of gently patting patients’ shoulders and charming them with a dazzling smile. This doctor was sitting next to the patient questioning him about her or his symptoms and life habits as long as it was needed to make a clear picture in regard to a patient’s health conditions. This was specifically important for Dr. Walter’s patients since the medical discipline he specialized in was diabetology, and diabetes is an intricate metabolic disorder requiring a lot of knowledge as well as understanding of minute details related to patient’s daily habits – the factor largely overlooked by many busy physicians. Sometimes Dr. Walter looked exhausted and nervous, but even the most skeptical patients were convinced that he had a professional interest – if not in their personalities, but at least in their health problems. It is this conviction that created a sustainable patient’s satisfaction and trust.

Genuine interest in a specific health situation is the hallmark of professionalism which patients immediately spot. It is manifested through the ability to listen and looking at the patient vs. impartially applying the prescribed clinical pathways. True, it is often safer for a physician to follow a recommended pathway avoiding the risk of your own decision. But a blind trust in the approved “cookbook” could pose a danger for patients.

In their book “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests,”the authors Drs. Leana Wen and Joshua Kosowsky describe a college kid who had a hangover after a night of partying. After saying she had “worst headache of her life” the “Rule-Out Subarachnoid Hemorrhage” pathway was immediately triggered. The girl went through the CT scan, which was predictably negative. Nevertheless, she would have gone through the enforced lumbar puncture, should she hadn’t escaped throughout a side door.

Patients and relatives do not expect enforced love and abundance of services from the medical staff. But they expect a professional attention and interest to cure their disease vs. its formal treatment.

Patient satisfaction can be bought.

One of the prejudices widely spread in the medical environment states: to achieve a high score on patient satisfaction simply give patients what they want. In an often quoted Dr. William Sonnenberg’s article Patient Satisfaction is Overrated the author suggests: “The mandate is simple, never deny a request for an antibiotic, an opioid pain medication, a scan, or an admission.”

educated patient

It is true that patients in pain may demand opioids to reduce sufferings. But after they are calmly and clearly explained that the overdose could be harmful, they normally stop insisting. What patient cannot tolerate is being inadequately treated due to deliberately misguided actions.

A patient I was observing was staying for a week at Intensive Care Unit (ICU) where he was recovering from a cardio surgery. The doctor confirmed that all tests were satisfactory to move this person back to his room. Looking at the patient one could clearly spot a fever. Nevertheless, a nurse was insisting that a temperature was quite normal. I went back to ICU and asked the assistant to give me a thermometer, explaining my concerns. He kindly gave it to me despite the risk of being punished for breaking up the rules: only the nurse responsible for a given patient was allowed to use a thermometer.

Apparently the assistant has valued the patient safety more than the rules in the hospital and, perhaps, more than his own career. The temperature of this patient was 39.5°C. He was urgently given antibiotics. The first question the doctor asked when he was informed about the complications was: “Who gave him a thermometer?” Of course I did not betray the ICU assistant for the sake of an immediate trust established between him, the patient and myself. I still do not quite get why the nurse decided to lie so outrageously. To be untroubled by additional care?

Doctor knows better.

The assumption that patient satisfaction depends on “giving them whatever they are asking for” implies that patients are ignorant and illiterate, another widely spread myth in the medical community (occasionally mixed with wishful thinking). A senior physician from Kaiser Permanente once honestly confessed that patients nowadays are often more educated about their illnesses than doctors themselves. “They have only one disease and it is their own, so they study it damn well, while we do not have time to read all the new literature coming out”.

One of the studies conducted by the Health Service Research among patients with type 1 diabetes showed that those of them who became familiar with their disease through trainings and the Internet were more knowledgeable than many of the healthcare professionals they have encountered.

The ability and willingness of patients to educate themselves, especially in cases of rare diseases, was confirmed by Professor Peter Mortimer of St. George’s Hospital in London. A world-renowned medical expert on lymphoedema told his Irish patients at an open day in Cork that they are “likely to know more” about the condition than the doctors who see them.

For medical professionals who believe that they receive their unquestionable authority and knowledge together with the white robe, the educated patient is a pain. Often such doctors perceive the patients’ questions as an attempt to challenge their professionalism. Some of them openly complain of losing the untouchable status of the pillars of their community the pillars of their community and becoming “like everybody else: insecure, discontented and anxious about the future.” On top of that such attitude makes the doctors “impatient, occasionally indifferent, at times dismissive or paternalistic”.

Contrariwise, for the physicians who have a still unsaturated curiosity and a professional desire to solve a problem, an educated patient can be a stimulating partner. When such a patient sees a genuine interest in her/his case, the level of cooperation between physician and patient is high.

Active patient engagement based on trust and shared knowledge can bring a distinct economic value to a hospital. According to one of the studies, patients who received enhanced decision-making support ultimately had 5.3 percent lower overall medical costs than those receiving only the usual support. The enhanced-support group is also characterized by 12.5 percent fewer hospital readmissions and 20.9 percent fewer preference-sensitive heart surgeries. Shared decisions making through these relatively low-cost models can extend the benefits of patient satisfaction and engagement [1].

Doctors who are concerned about their intact authorities more than about assisting their patients are rarely good doctors. Behind the paternalistic aura or play-acting behavior hides the inability or unwillingness to learn new discoveries in their professional area to meet the growing demands of their patients.

The last word on “empathy”

“Empathy” and “kindness” is on the radar of professional discussions. There are even suggestions to include ethical courses as part of medical education curricula. But can one really teach compassion or “study” empathy? Sympathy is not something you learn at school unless you protected your weaker friend from the bunch of thugs or brought home a bleeding cat that had been hit by a car. One can try to mimic kindness, but people always spot when it is fake.

Those who are venturing to go to the medical profession are accepting the burden of responsibilities to serve their patients at the risk of their own well-being. We see such doctors in the Red Cross and the “Doctors without Borders” organizations. They deserve our unanimous respect.

But let us be honest: not everyone is born to do this job. Physicians who are indifferent to their patients are not full professionals and should not be considered as ones, although being indifferent to patients is occasionally considered a right attitude within the medical community. You cannot be a professional in the subject you dislike, especially if it is a human being. People are visiting physicians not to spend their time on enduring tortures and risky procedures. They expect results. Citizens are paying for their conditions to be clearly improved with their time, money and health. Healthcare professionals should never forget about it.

References:

  1. http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86

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