The Doctor And The Patient: Relationship, Partnership Or Marriage?

I once heard a doctor say he viewed his relationship with his patients as a marriage. Separately, I heard his patients discuss their feelings of safety and their ability to maintain their power working with him.

Using marriage as an example of the relationship between doctor and patient may seem strange, but a look at how we view marriage may clarify the comparison. Recently I read an interview with Joseph Campbell, author of such books as Power of Myth, and The Hero’s Journey, in which he discussed marriage as an ordeal. Poet and best-selling author Robert Bly (A Gathering of Men and Iron Man John) referred to the relationship in one of his poems as “a third body” created by a man and a woman. And I have always considered marriage to be a struggle.

The “struggle”, “ordeal”, or “third body”, all refer to an entity created by the relationship that is greater than the individuals involved. As a physician, this is my hope for the doctor/patient relationship: that it will become an entity greater than the individuals and allow each to achieve their full potential.

Listening is the key

What steps must be taken to have this happen? From my experience, it starts with the physician listening to the needs of the individual. Not everyone with the same diagnosis has the same experience. One individual’s description of his experience may be, “a monster eating me up alive”; another’s, “a gift and a challenge.”

Listening is not something physicians have been trained to do. It is a skill that must be worked at. Doctors can improve their listening skills by asking their patients what they are experiencing, and encouraging them to share feeling words to describe what they are going through. Another way to help people express their unique needs is for the doctor to ask, “How may I help you?” rather than, “What is wrong with you?”

Patient vs. respant

The word “patient” actually means “submissive sufferer.” Rather than treat people as “patients”, physicians need to allow each person to become a unique survivor, or “respant”–a responsible participant.

If doctors view death, or the lack of a cure, as a failure, then they all fail at some point. Instead, they should look at the challenge and help each person become heroic in their actions. They should guide people to express themselves and use the disease as a “path report”: a report as to whether they are on their path in life or not. They should guide them to find psychotherapeutic help and to join groups that truly support and empower the person. I also advise medical students and doctors to have their own weekly support groups.

Feelings are chemical and need to be dealt with as another factor affecting survival. By expressing feelings, we can enhance the internal environment and resistance to disease. In the doctor/patient relationship, the doctor should never lose sight of the fact that patients are not statistics. Hope and humor are always appropriate in the relationship: they have an effect on the body and the beliefs of the individual that help them respond better to treatment.

Where are the good doctors?

A painting by Sir Luke Fildes called “The Doctor” hangs in the Tate Gallery in London. What image does the title conjure up in you mind’s eye? Well, it simply shows a man in normal clothing sitting in a cabin with a sick child and his parents. No instruments, no white coat, just a person. I have learned that the request, “Where can I find a good doctor?” is really a question about where to find the man portrayed in this painting. There is no reason why our medical training can’t provide good doctors everywhere, so that people will not need to ask or to search. But for this to happen, medical education must evaluate itself and each individual must look inside for his or her reasons for becoming a physician.

And, we must accept our pain and respond to it. Recently I saw an ad in the New England Journal of Medicine placed by a pharmaceutical company. The ad said, in effect, “I went to my doctor and said, “I’m depressed and unable to cope. You’ve got to help me.” The doctor handed me a prescription for an anti-depressant.” Is that what we want the doctors of the future to do when people cry for help? Just hand them a prescription?

I would rather see doctors inviting their patients to sit down and tell them what they are experiencing in life and asking, “How may I help?” I want to see doctors put their desks against the wall and step into life and the patient’s world; to stop being a tourist and become a native in a new land.