A Simple Matter of Mutual Respect
My new patient switched to me from another doc. He said it was because the other guy “had the personality of this desk,” thumping the table below my computer. Then he paused, “Actually, I may have to reconsider, that is a pretty nice desk…” He frowned and then looking up, grinned. He went on later to tell me that the previous physician was fine, but, “He is thin.” I tried to keep from squirming in my 165 pound 5’ 11” frame, roughly half the weight of the guy talking to me. “He’s a vegetarian.” Again I try not to bat an eye, I do eat meat, but certainly the principles of eating healthy are high on my priority list. “He rides a bike.” I try not to cough, and I look down to type some words in the EMR wondering if he has noticed that all the magazines in the room are my old Bicycling and Mountain Bike Action issues. But then, the real rub is revealed: “And I think he looked down on me for living the way I do.” Suddenly, confidence rushed back into my being and I almost caught myself sitting up straighter. I have plenty of faults, but I am determined not to make looking down on my patients one of them.
This brings up great and really tough questions I wrestle with often. How do I get patients to change their health for the better? How do I do it in a way that is not condescending? How do I keep myself from starting to feel aloof or smarter or better than them? How do I keep myself from saying things like “them” as I did in the last sentence to differentiate me from my patients? After all, I am someone’s patient too. Sure, I went to school forever and my new guy didn’t, so I can say stuff like “fibroepithelial polyp” and he can’t. But when I think about it, he can fix a forklift and I can’t. Actually, that very well may be the key.
I had already done the groundwork with my newbie, and gotten his confidence, otherwise he never would have told me all of his concerns about his last doctor. He might have thought, “Here is another skinny health nut who has the personality of a plain (fake wood veneer) desk.” I spent the beginning of his visit asking him about his work. I really was genuinely interested in his job as a fork-lift repairman. “So you have to travel from store to store and carry your tools with you?” “You never know what you might encounter?” “Hard to plan for your day I guess?” A wise professor from med school said to find out what the patient is an expert in, and let him or her know you respect that. Then you can be an expert in medicine, and your patient can respect you. I think it works, and really there is nothing particularly “doctorly” about this advice.
[inbedded quote: A wise professor from med school said to find out what the patient is an expert in, and let him or her know you respect that. Then you can be an expert in medicine, and your patient can respect you.]