Notes From The Battleground

The patient-physician relationship is one of battle from the start. Even before seeing her first patient, the medical student is schooled in the patient-physician relationship. This takes the form of a lecture, given by a medical malpractice lawyer, who goes over case after case of “horrible lawsuits” where the doctor “got too close to the patient,” “became their friend,” and this was a “practice-killing mistake.” The lawyer coaches these young medical minds to think as if they are on the stand, testifying to save their medical license from being revoked with every diagnosis and treatment made. The doctor is to always be on the defensive. “Document or it didn’t happen” is repeated several times a day over the next few years of training. Fight on!

Upon graduating from residency, the doctor attends meetings given by their malpractice carrier to ensure adherence to strict “patient protocols.” Monthly emails are sent out detailing the current liability pitfalls. Doctors are given resources as to how to manage patient complaints. They are given courses in how to convince patients to comply with the agenda du jour, which today happens to be about vaccines. And if the patient does not comply, they are kicked out of the practice, and notices are plastered all over Facebook showing how the doctor is “winning” the fight.

Physicians are to only discuss treatment options with a patient that can be found in a respected scientific journal, based on double-blinded, peer reviewed studies. This “Evidence-Based Medicine” was designed to keep patients safer, but how does knowing about fidgeting and mortality risk really helping anyone? The doctor within the system is told not to trust their own eyes or hands. The diagnosis must not be made subjectively by physical exam, but rather by “objective” invasive lab studies and imaging. How does “objecifying” a patient really heal? 

The receptionist is placed between the patient and the physician when questions arise about medication dosing or side effects, which leaves plenty of room for misinterpretation and injury. And does it have to be so cold in the exam room? “Here, put on this paper gown, the doctor will be in shortly.” There are framed diplomas on the wall, as a sort of muscle flexing posturing. The room smells like bleach, there was a battle lost in the room even before the patient stepped inside. Twenty minutes later, the doctor comes in, hiding behind his white coat, a stethoscope around the neck. One might assume a doctor that listens to your heart is trying to connect to your heart, but really the stethoscope stands as a clear message of a non-equal playing ground.

Almost immediately, shots in the form of rapid-fire questions are fired across the bough with only seconds for a patient reply. Often times the patient has no idea if their reply was even heard. The doctor is writing in the chart (or typing on the computer). They fill out areas such as “Chief complaint” and write in “No known drug allergies,” essentially covering their own behind because, well, it’s not the doctor’s fault if the patient doesn’t  know. Any areas of questioning that do not reveal disease are instead written up as “Patient denies chest pain, Patient denies smoking.” Never is it written, “The patient is making a valiant effort.” Instead it is recorded as the “patient feels they are experiencing” symptoms x, y, z, and not the “patient experiences” those same symptoms. There is a high level of subjectivity placed on the patient’s own experience, while the doctor is encouraged place their own objectivity on that experience, devoid of feeling.

Of course when the table is turned, doctors make the worst patients, as the saying goes. We doctors are acutely aware of the gaping disconnect when we are the patient, the lack of being seen. It’s no wonder even top heart surgeons die of heart attacks. Doctors themselves are witness to the lack of warmth and connection in patient after patient. We see high rates of drug and alcohol dependency and burnout in our doctors. We know that this lack of a witness leads to the 400,000 medical errors per year, and interestingly enough, these are are blamed on Information Technology Systems. The irony is not lost here. Putting a “false intelligence” between the patient and their doctor will predictably lead to problems.

Doctors are taught to keep their distance. A respected doctor is one who has the Meyers-Briggs grouping of ESTJ. They “live in a world of facts” and have a “clear vision of the way things should be” but “may unknowingly hurt people’s feelings by applying logic and reason to situations which demand more emotional sensitivity.” Healing, anyone? I happen to be an INTP and “approach problems and theories with enthusiasm and skepticism, ignoring existing rules and opinions, defining my own approach to the resolution.” This sounds about right, as my patients have already been to the “expert” and are now seeking someone who questions that status quo. But INTP is not the culturally accepted model of a physician, and God-forbid the physician has feelings, so they can “best serve humanity.”

Well then, what is a well-informed patient to do? Engaging in the fight certainly isn’t going to help the healing process. To heal ourselves and our community, we need to drop out of the battle. You can’t fight in a battle you don’t show up for. We don’t need any government body to give us permission to heal. We can stop counting on the ego-consciousness of the authoritarian health system and develop our own communal ego-consciousness. One built on warmth, and sustainability. And connection. We can find real care, whether through an alternative healthcare practitioner, your spouse, or your yoga teacher. Seek out those who are great at self-care, they will teach you self-compassion. We can find our own sense of uprightness, our own beacon, our very own ego-consciousness. We can teach others and bring them along with us. But first, we step away from the fight.