Dr. Jeff Kane: An unnecessary choice
Many years ago I taught a class called Philosophy of Health in a community college. I asked the students, “Would you rather have a doctor who’s technically competent or one who’s warm and compassionate?”
The answers split the class three ways. Some voted for competence, some for compassion, and only a few for both. One student wrote, “Who are you to give me such a dismal choice? I want it all.” He got an “A.”
Surprisingly, most people feel it’s an either-or issue. I’ve heard from many patients some version of, “I don’t care if my doc is a hugger. I just want him or her to be competent.”
This unnecessary choice affects doctors, too, and causes them no end of grief. I was with one whose patient, a young woman with chronic arthritis, was crying in pain. If the thought balloon over the doc’s head were legible, it would have read, “This poor young woman is suffering horribly. I want to get up and just hold her…but that wouldn’t be professional.”
He wrung his hands, his two aspects struggling with one another. In the end he stayed put, resumed an impassive face, and wrote her a prescription for a stronger painkiller. Afterward, he told me that yes, indeed, he’d felt ripped in half.
Docs widely report similar dilemmas. An article in the New England Journal of Medicine described a woman with a history of tenuous relationships and loneliness who complained of intractable diarrhea. The patient pointed to her belly and sobbed, “I can’t hold on to anything!”
Struck by that metaphor, the doctor felt it’d be wise to inquire further, but twenty-five minutes had already passed, and she didn’t have time to pursue it. “If I ask patients about themselves,” the doctor wrote, “I might learn what’s really going on with them, but then I’ll fall hopelessly behind and feel more burned out. And if I don’t ask, I’ll miss out on the kind of intimacy that not only helps the patient but nourishes me. After this patient left, I was on the verge of despair.”
Patients and doctors alike, then, generally assume that docs need to choose one style or the other, that a single person can’t enact both, and even if that were done, it’d necessarily take longer. A deeper relationship between patient and doc can indeed seem to take longer, but would you rather have twelve ineffective visits of ten minutes each — the current national average, by the way — or one effective visit of forty minutes?
Jeff Kane is a physician and writer in Nevada City.
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