We All Need A Dose Of The Doctor

You're the doctor. Your patient feels ill, but you don't have anything curative in your medicine bag. What do you do? That question has long stymied physicians. But as the Hungarian psychoanalyst Michael Balint recognized a half century ago, persistent or mystifying symptoms are not necessarily untreatable. Listen to patients' stories, Balint urged his colleagues. Treat them as friends. They may need a dose of the strongest drug of all: the doctor.

Balint's prescription is as timely today as it was in the 1950s. A founding insight of mind-body medicine is that everyone needs a dose of the doctor, even when state-of-the-art tests and treatments are available. Patients who have a good and trusting relationship with a clinician are more satisfied, studies show--and satisfied patients get better clinical results. They're more motivated to take care of themselves, more comfortable seeking help when problems arise, and more willing to follow advice and take medication as prescribed. A healthy doctor-patient relationship can also give consolation when bad news comes. Whether the diagnosis is HIV or heart disease, a patient whose doctor is a comrade doesn't have to worry about being scolded or abandoned. The relationship itself provides an emotional safety net.

Yet as science confirms the power of the healing relationship, other forces are conspiring to undermine it. Our health system can leave both patients and doctors feeling stressed out and alienated from one another. Relationships take time--and time is short in the world of managed care. Fifteen minutes may be long enough for a skilled practitioner to diagnose an infection and dash off a prescription or a referral to a specialist. It's rarely long enough to make sense of another person's experience, convey that understanding or act as an advocate. At its worst, our system of managed care can turn the doctor-patient encounter into an anonymous retail transaction.

The medical profession, to its credit, is struggling to revive the healing relationship. The medical schools at Harvard, Columbia, Duke and the University of Arizona have all created programs intended to pull medicine away from an exclusive focus on disease and toward the promotion of wellness, stressing the doctor's role as partner, teacher and coach. And at least two thirds of all U.S. medical schools now devote some part of their curriculum to integrating conventional care with complementary and alternative therapies that patients find more friendly. With the right reorganizing of priorities, the system can still cultivate a deeper role for physicians.

Consumers, for their part, are not waiting passively for the medical system to change. They're venturing outside of it in search of healing practices that involve less technology and more of the human touch. Few of these patients would give up effective drugs or surgery in favor of more sympathy, but most recognize that pills and procedures are an incomplete model of care. They want a dose of the healer who remembers their name.

Even the best doctor-patient relationship has boundaries, of course. No one should expect a parent's love from an internist (or a shaman, for that matter). But anyone with access to health care can take steps to improve the therapeutic exchange. Step one is to communicate freely. Educate yourself about whatever condition ails you, and share the information you find. Don't hold back for fear of being a nuisance. A good clinician is eager to teach and learn, and willing to acknowledge medicine's limits. In fact the healing relationship sometimes grows stronger when a doctor runs out of more treatments to offer. In that moment, he or she sheds authority and becomes a peer who is struggling forthrightly with the emotional consequences of illness. Doctor and patient become allies in an effort to sustain hope and find meaning in suffering.

For a healing relationship to thrive, then, patients must be experts about their needs, values and objectives. Doctors must be experts on wellness and illness and have finely attuned eyes, ears and hands. Few physicians emerge from training without some qualms about caring for other people. We become good at what we do by learning that even when we can't cure illness, we can make it less baffling and less onerous. The value of the doctor-patient relationship is not always easy to measure, but it is always immeasurable.

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