Obstacles Physician Patient Relationship. Must Include Quotes

¶ … obstacles physician patient relationship. Must include quotes citation Deborah Tannen writing "Talk the Intimate Relationship"

Obstacles to a good physician-patient relationship

The physician-patient relationship is one of the most intimate and important relationships in many individual's lives. For the relationship to function in an optimal fashion, patients must often share information about their lifestyle habits, personal aspirations, sexuality, and feelings about their spouses with their physicians. However, a physician's desire to maintain a professional distance can result in communication barriers that inhibit the sharing of such thoughts and feelings. Examining some of the barriers that exist between patients and physicians, using some of the ideas and concepts from relationship therapy, and the differences between men and women can be useful. For example, according to Deborah Tannen's essay "Talk: The Intimate Relationship," the reason men and women often experience barriers to intimacy and a full and free flow of dialogue is that "male-female conversation is cross-cultural communication. Culture is simply a network of habits and patterns gleaned from past experience, and women and men have different past experiences. From the time they're born, they're treated differently, talked to differently, and talk differently as a result."

This is also true of physicians and patients. Physicians are acculturated into a different viewpoint of the human body: they see the body in a scientific fashion that may seem cold and unemotional to their patients without medical training. A patient that has just been diagnosed with cancer's first immediate thoughts is: "will I survive?" From a physician's point-of-view, this question can only be answered in a qualified fashion -- it depends on the type of tumor, type of cancer, and treatment options. The physician will often use the language of science, while the patient reacts in a far more personal fashion, wondering what the impact of the disease will be upon his or her future an the future of his or her family.

The physician does not nor should not put his or her medical education to the side when counseling a patient confronting a serious illness. But the doctor must remember that the patient does not necessarily speak the language of medicine and science, and understand the psychological barriers and difficulties absorbing serious medical information, when talking to the patient. Furthermore, acting with sensitivity and grace to the suffering of the patient will actually improve the patient's ability to retain information and to make good decisions. This is especially important when quick decision-making is required, such as in an emergency room. For example, a parent may need to authorize treatment for his or her child. The "meta-messages of talk" or the value of bonding with apparently inconsequential chatter should not be discounted in the physician-patient relationship.

Sometimes, patients can project unintended emotional meanings into a doctor's standard operating procedures. For example, when a patient receives a screening procedure such as an MRI, he or she might not understand why the results are not read immediately by the doctor. For the doctor, reading such results is simply part of the daily routine, and the patient's results are one among many things he or she has to do. The patient may not perceive that the doctor has many other patients, because of his or her emotional feelings about the test. The patient may perceive the doctor as incompetent or uncaring as a result, and be less apt to view the doctor in a positive fashion.

Doctors may also feel frustrated when the patient vents his or her displeasure about the medical system as a whole upon the physician. The patient may be angry that his or her insurance company has denied coverage of a procedure the doctor has suggested and feel confused, and take out this anger against the doctor. "Why did you recommend this to me, when you knew it wouldn't be covered?" The patient cries, even though the doctor could not have known that the insurance company would not cover the procedure. In fact, the doctor may be just as upset at the insurance company, but the patient perceives the entire medical system -- of which the doctor is a part -- as uncaring. Some patients may even be resentful of doctors that give them bad news, even though logically they know it is not the doctor's fault that they are disappointed with their prognosis.

The doctor must also understand that quite often he or she represents, in the patient's mind 'all doctors,' and patients with negative perceptions of doctors or the medical profession may vent their feelings against an individual doctor. (This is not unlike how intimate relationships between men and women can become derailed because the male or female has had bad relationships in the past, and projects those feelings unjustly onto his or her current partner). Quite often, a doctor may be confronted with a patient who says: "I've never liked doctors," and is not willing to judge a doctor's individual expertise on a case-by-case basis.

But patients who expect to be treated fairly may find themselves combating physicians' prejudices. Some doctors may be prejudiced against young women, or older people, and assume that they are not competent to judge their own health, such as their pain thresholds. Members of certain races or socioeconomic classes may also encounter prejudice amongst physicians. Simply because someone is a doctor does not mean that he or she is above the foibles of being human. Prejudices, however, can cause a doctor to ignore important information conveyed by the patient, just as a patient's anti-medical prejudices can result in him or her discounting legitimate warnings or advice from a doctor: "oh, those doctors never know what they're talking about. My cousin smokes just like me and he's never had lung cancer," a patient might tell him or herself.

The barriers to communication generated by the different styles and assumptions that exist between the scientific and layperson's community are even more difficult to overcome when the patient and the doctor come from entirely different cultures. In some cultures, the idea that a family takes care of older members itself is of profound significance, and physician from outside that culture might not understand why a family would take offence when he or she suggests that a grandmother receive visits from a nurse at home on a weekly basis.