Asking something about the other person: what doctors and patients have in common
Crossposted, as you should know by now, to the blog at Talking To Your Doctor.
One of the many useful pieces of advice to doctors that Atul Gawande proffers in the last chapter of his Better is that a doctor should ask every patient about something in their lives unrelated to their health complaint. Of course, this can easily give rise to unintended consequences. I asked one patient of mine, a guy in his fifties with an accent from the Maryland shore, what he liked to do with his time. “I like to race horses,” he said, and when I was surprised that he didn’t seem the jockey type he made it clear that he played horses. Or, rather, gambled on horses. There’s nothing wrong with that, but it might not have been a personal interest he would have shared with me otherwise.
Sometimes I wonder whether patients are going to ask me about my life. They ask about my kids, which is generally a safe topic, but not much more. It’s clear why: doctors and patients are careful about boundaries for good reason. We are partners in health, ideally, but not friends or relations.
In the healthcare encounter, however, we have a lot more in common than we might realize.
We both think we know more than we actually do. Doctors like to assume they act based on evidence, when mostly they (we) don’t, or the evidence is incomplete. Patients think they know their bodies – and they do, they are the ones most familiar with them. But knowledge of one’s own body doesn’t necessarily entail a prediction of what a set of symptoms might mean. We each need the other to be informed and educated out of our complacency.
We think the other is not doing a good job. Doctors roll their eyes at patients who don’t take their medications exactly as directed, even though doctors – playing the role of patients – do exactly the same thing. And the reason patients don’t take medications is not just to be ornery or contrary: it’s because they don’t know how; are worried the medication might be making things worse; can’t afford to fill the prescription; or are afraid to tell the doctor they don’t agree. By the same token, doctors are put in a spot by patients assuming the absolute worse the minute they enter the exam room.
Maybe, then, doctors and patients should start asking about each other’s lives more often (on suitably inoffensive topics, of course, like kids, favorite desserts, weather, and vacation plans). There is plenty of common ground. Perhaps we can expand it.
