Angry Doctor

Friday, November 04, 2005

Clues for the Clueless – Chapter 3

Chapter 3 – I don’t like you

Personally, that is.

Not that I actively dislike you (I might…) but like and dislike on a personal level do not enter into my consideration when dealing with you as a patient.

Even though we say otherwise, doctors do not view patients as persons. You may be a case, a customer, or at the very most a patient viewed in the context of his role in his family, his workplace, and in society, but it’s still not personal.

And we should keep it that way.

Because I never want to judge you as a person. I don’t want to compromise my care for you because you are a racist or a sexist. Likewise I will not give you better care because you and I share the same hobby or drink the same brand of beer.

I will give you the best care I think you need, in the best way I know how.

I may tailor my care for you based on your family and home situation, your work environment, and even your religious beliefs, but I do so professionally, not on a personal basis. Even when I help you sort out your messed-up life, I am still doing it professionally, not personally.

(Think your doctor actually likes you? Tell him or her you can but will not pay a single cent for consultation or medication but want to continue your follow-up there and see how quickly he or she stops liking you…)

So don’t expect me to like you. You don’t need my approval as a person.


  • To angry doc,

    Er regarding this "I cannot pay" business. You'll be surprised. A lot of older GPs actually have such good relationships with their patients that the more regular the patient, the better a friend he/she becomes, the less he/she is charged and the medicines are all sold at cost price or on credit or in some cases given free!

    At least that's what happens where I work and my boss is insanely nice to his "regulars".

    And so that's what we are up against in the highly competitive world of medicine.

    I'm afraid I would disagree with you regarding the relationship I would want to have with my patients. I do want to be friends with them. I do want to get to a level boredering on personal terms with them, all the while maintaining professionalism when it comes to the technicals of medicine. I prefer that.Of course in SINGAPORE the problem is that the patients have to pay for our bread and butter. And of course being SINGAPOREANS, people are always looking for a free lunch. So when you get personal they will ask for free lunches.

    Well that's why I am going to Australia to continue my medical career. There the govt pays for the consult, not the patient. So I can get personal with the patient and not worry that they will be asking for discounts cos the govt pays for their consults I just need to get them to like seeing me.

    Isn't that what we all wanted as doctors? Isn't that what COFM teaches us abotu doctor-patient relationships? Or has NUS started teaching doctor-customer relationships in COFM?


    By Anonymous Anonymous, At November 04, 2005 11:16 am  

  • Not 'I cannot pay', but 'I will not pay' lah.

    Not quite sure what COFM is teaching these days though... perhaps some of the medical students can enlighten us?

    By Blogger angry doc, At November 04, 2005 5:03 pm  

  • You seem awfully vitriolic and cynical there angry doc ;-)

    Deficiences in public healthcare funding over here in Oz in the last decade or so have led to a burgeoning two-tiered system of health care...which saddens me personally...but it sounds like you poor guys are hamstrung by this 'user pays' only system. One needs to put bread on the table, at the end of the day...

    I consider it a privilege to help each and every one of my patients. And developing rapport with one's patients is not only integral to good medical care but facilitates our own learning - after all, are not patients our greatest teachers ?
    We are all trained to do this without ever needing to transgress boundaries. Nonetheless we are also would expect more empathic than most given our chosen profession...and I would be lying if I said a patient had never made me angry or caused me sorrow. Obviously I do not allow these emotions to affect care, but these kind of things fester if they're not processed.

    And no, I'm not a shrink :)

    By Anonymous Anonymous, At November 04, 2005 6:31 pm  

  • COFM taught us to shift from paternalistic health care to patient-centred healthcare.
    we no longer dispense advice and medicine and expect people to listen.

    we must build rapport with them, listen to them, understand them, and by the way, the barley water thing?

    that was an example quoted by A/P WML.. she mentioned that antibiotics were perceived as heaty and suggested that we could tell them to drink barley water.

    i wouldn't know about advising patients to take stuff outside my field of knowledge, but well..

    'explore the patient's beliefs and practices.
    acknowledge them.
    evaluate them:
    harmless - leave alone
    beneficial - encourage
    uncertain - do further study but leave alone for the present
    harmful - change cautiously through health education"

    i guess the problem is what you perceive as harmful and what the patient sees as beneficial and how you'd change that.
    in any case, there are probably some who think that everything outside western medicine is harmful.

    but i think barley water is harmless enough..

    By Anonymous Anonymous, At November 05, 2005 11:41 am  

  • I know about the barley thing; they use that example every year, I think. :)

    The difference is between telling him 'no barley! very harmful' or 'yes barley! very cooling', both of which I think are wrong because you don't KNOW that it is one or the other, and saying 'I don't know, but I also don't know it's harmful so I won't stop you from taking it'.

    I think we need to as a profession re-examine this attitude that it is OK to play along with a patient's belief when we don't know the facts.

    By Blogger angry doc, At November 05, 2005 11:56 am  

  • wah lau.. they reused the barley water thing?
    heh the patho slides never change either..

    hmm.. we don't know a lot about western medicine either.
    was studying stuff like DMARDs - how do gold compounds and anti-malarials work in treating arthritis? mechanism unclear..

    a lot of stuff in western medicine also unclear, unknown.

    i don't think we'd "play along" with the patient's belief..
    play along sounds too condescending.
    i think what the COFM people are trying to get across is that different beliefs exist, and we shouldn't think we're always right.

    we recognise they exist and we respect them, absurd as some think they are.

    seriously, i'd tell them i know nuts about alternative medicine and if they dowan to take antibiotics cos it's heaty, then i can't do very much either.

    i don't understand the fuss about offending your patient such that you lose his business.
    somehow i'd like to think that doctors don't just dispense antibiotics to please the patient and keep them happy and coming back.

    ok maybe i haven't started working so i really dunno.

    too idealistic eh?

    By Anonymous Anonymous, At November 05, 2005 9:42 pm  

  • Dudes, it's NOT about the barley! :)

    I suppose you can say you are idealistic... which means COFM has still some distance to go in teaching you guys the realities of work.

    My advice is this: what COFM teach is just a guideline. YOU must choose whether to adopt them as your way of practising, because once you choose to, YOU must take personal responsibilities for your actions. 'The professor said this was the right way to deal with an unreasonable patient' isn't gonna cut it in the real world.

    Once you are in your own practice you have to decide for yourself what kind of doctor you want to be.

    Once you are out there, you are no longer doing it to pass a written or oral exam. You are not doing it to please your professor or tutor.

    And to borrow from Dr Cox in 'Scrubs', you are not even doing it to please your senior doctors or clinic or hospital administrators. Hell, you're not even doing it to please your patients.

    The only person you have to please is yourself.

    At the end of the day, you must go home thinking that you have not failed yourself as a doctor AND a person.

    I don't mind going home late. I don't mind going home feeling pissed with unreasonable patients, bosses, or colleagues.

    I don't mind going home with a stack of complaint letters or even a law-suit hanging over my head.

    But I hate going home feeling guilty.

    By Blogger angry doc, At November 05, 2005 10:08 pm  

  • Did you guys (or your wives/gf) watch the korean drama Dae Jang Geum (Da4 Chang2 Jin1)?

    She demonstrates the basic qualities and philosophy a good physician should have... : )

    By Anonymous Anonymous, At November 06, 2005 10:08 pm  

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