Doctors as Mirrors – A Reflection on the Doctor-Patient Relationship




Health and Healthcare CategoryHas this scenario ever happened to either you or somebody you know? You get a raving endorsement from a friend or family member about the doctor they saw, and how they’re the best thing ever, and how you absolutely MUST go see them immediately? How many times has somebody actually gone to see a doctor based on that recommendation, only to be underwhelmed and confused about the beaming review?

These are cases where people fell victim to the cult of personality. The doctor-patient relationship, just like any other relationship, takes on many forms. What works for one person may not jive for another. Because medicine in the United States is an essentially free market, doctors tend to carry a kind of gravity about them. Patients that like their doctor’s style stick around and recommend others, while the relationships that don’t work fall apart and the patients end up drifting away to another doctor that better suits them. The end result is that a doctor’s practice and patient base becomes a direct reflection of their personality.

DoctorOf course every relationship is different and nuanced, but doctoring styles tend to lean towards one of two broad flavors:

Paternalism

I’m the doctor, you’re the patient.

Docs of this tradition believe that they are the absolute stewards of the human body, and that patients come to doctors to be told how to improve their health and treat their disease. In an encounter there is generally not much room for questions or discussion on the part of the patient. Furthermore, doctors who practice this way may get offended or disdainful of patients who second-guess their decisions or ask for other opinions.

Partnerism

Doctors of this ilk view themselves more as guides, or consultants. They have spent the time studying and honing their skills to become experts in the human condition, and believe the patient is the ultimate steward of their own body. Patients come to physicians for their expertise, in order to gain some insight into what may be happening to them, and information required to make their own informed decisions about health management. Doctors who subscribe to this philosophy tend to push a lot onto their patients, which they may or may not be in a position to handle.

Needless to say, the potential for conflicts between doctor and patient personalities and their expectations of the doctor-patient relationship can happen very frequently. So what kind of doctor do you have?

  • Jason Victor

    I’ve seen these approaches used in business situations, as well, called “Directive” and “Supportive” depending on the situation. For example, large lectures tend to be Directive in nature and brain-storming sessions lend themselves well to “Supportive”.

  • (I am belatedly to this article via my Google Alert for “doctor patient relationship.)

    “Paternalism” isn’t always bad, “Partnerism” isn’t always desirable. Many patients, especially the elderly, those from other cultures, and very sick people often want a more take-charge type of physician. Some patients become more assertive, less passive and dependent, as their illnesses resolve. As an MD, I’ve been amiss when I’ve erred on the side of partnerism with patients who, for the reasons I gave, were uncomfortable with that balance. You allude to this when you say “Doctors who subscribe to [the partnerism] philosophy tend to push a lot onto their patients, which they may or may not be in a position to handle.”

    I teach a course in doctor-patient communication at Stanford University. Stanford Medicine and Horsemanship employes horses to teach bedside manner and other interpersonal skills. Just like some horses need a strong hand and some horses like to be asked and guided, patients gravitate to the type of doctor–more directive or more peer-oriented–that serves them best. The important thing that we teach is awareness of the spectrum of manner, from more active to more passive, and respect for where on the spectrum one is comfortable–and yet is still respectful to the patient.

    Beverley Kane, MD
    Palo Alto, CA

Sajid Surve, DO

Sajid Surve, DO, is a physiatrist, acupuncturist, and osteopath who specializes in musculoskeletal medicine and integrative medicine.
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