I’m sometimes uncomfortable about the way we doctors deal with our patients. I am a doctor, and I’m wary about apparently criticising other doctors in a way that comes across as though I regard myself as somehow virtuous and without flaw. I am human, like everyone else, and I’m clearly fallible. However, I also struggle with the idea of sitting quietly by when I see what I regard as poor medical care.
Some of my concerns relates to certain practices in medicine where I believe people are often misled about the likely risks and benefits of some form of treatment or investigation. Not so uncommonly we doctors and the system in which we work can exaggerate benefits and not properly explain the real risks of some aspect of care. I believe this to be generally true of things like statin therapy and some health screens including prostate cancer screening and mammography. Quite often I write about these issues on this site.
Sometimes, though, I take issue with poor medical care that appears to be sometimes related to, well, a lack of care. And by that I mean what appears to be a lack of genuine concern for other individuals and the absence of a deep desire to help them achieve their health goals.
About half the patients I see in practice are unhappy with their regular doctor or medical practice. I do not assume from this that half of people in the UK feel they’ve been failed by the conventional medical system. By the very nature of the work I do and the way I do it I recognise I am likely to attract a high percentage of people who are not happy with their standard medical care.
That notwithstanding, though, I am often struck by how often a patient with volunteer that they feel their doctor ‘does not care’, or ‘doesn’t even look up when he/she talks to me’, or ‘just stares at the computer screen’. Medicine is supposedly a caring profession, and people generally have an acute sense for how much their doctor actually cares. I have found that patients will forgive their doctors many things (e.g. not knowing everything, making a mistake but apologising for it), but if they sense lack of care then trust usually goes with it and then any useful and meaningful relationship is essentially over.
What made me think about this today was a short piece I found online in the Wall Street Journal from a certain Dr Harlan Krumholz. You can read the piece here but here’s an extract from it:
With the advent of digital record keeping, I worry that we are losing the ability to look our patients in the eyes, listen intently to their fears and concerns and provide the support and caring that is so necessary for a relationship that promotes healing. I have always thought that the conversations with patients have the potential to be therapeutic or harmful. We can promote the kind of communication that enables patients to be better able to make difficult choices, to be more confident in pursuing the strategies they choose and to be more likely to achieve the results that they desire. And we need to avoid the kind of communication that alienates patients from the health-care system, inhibits them from honestly disclosing how they feel and what they need, interferes with their ability to make the choices that best fit them and reduces the likelihood that they will get the outcomes they desire.
I defy any doctor or anyone else to find fault in any of what Dr Krumholz expresses here.
It is perhaps notable that Dr Krumholz is a cardiologist and also a professor of medicine at Yale University School of Medicine. Dr Krumholz has featured a couple of times before on this site as someone who has expressed doubt over the wisdom of current cholesterol management policy (see here and here). I don’t know Dr Krumholz, have never met him or corresponded with him, but just reading his views on cholesterol and the doctor-patient relationship suggest to me that he has a deep care for people. To my mind, Dr Krumholz exhibits a quality that is essential to good medical care, and I personally wish there were more doctors like him.
