The Doctor-Patient Relationship

My partner’s patient came to the office today to be evaluated prior to the next cycle of chemotherapy. Let us call him Bob. Bob is in his late 60s and has stage IV cancer. As my partner was rounding in the hospital, I saw Bob instead.

Bob looks ill. His bald head accentuates his temporal wasting. Cigarette smell is so concentrated that I can get intermittent whiffs of it even with wearing two masks. I was fore-warned by my nurse that this patient is not compliant. He misses his appointments from time to time.

I reviewed his patient chart a couple days in advance. He is still smoking a pack of cigarettes a day. He started on a new regimen chemotherapy about 3 months ago.

When asked about cutting down on smoking, Bob argues that he cannot undergo the hardship of quitting or the nicotine withdrawal during chemotherapy. When asked how he is feeling, Bob says that he felt some pain at the back of his one ear, which has happened in the past. I advise him to have a brain imaging study done but he refuses. He has audible wheezing on exam. He requests me to refill his inhaler and refuses to see a pulmonologist. I discuss that he needs a longer acting respiratory medication (and quit smoking) – he refuses again.

In the past, it would bother me very much if patients did not agree or adhere to my recommendations, or if they were not compliant. It would bother me even more if they decided to see another doctor instead.

That was when I focused more on how other people perceived me. Yes, taking great care of patients was important too. I somehow thought that I needed the patients’ stamp of approval to conclude that I was a great doctor. I did not think enough of me to be a good doctor. The external validation seemed to be what I needed.

How wrong was I! First, I am a great doctor no matter what, because I pour out my heart and I use the knowledge I absorbed to the best of my ability. Second, patients (or other human beings in general) can choose anyway they want to think of me. The most important opinion is my opinion about me. It is time to give myself more love and respect.

Third, we are all human beings. We have our own minds and unique ways to think of things. We have our personalities and differences. It is okay to have different opinions, and it is ok that we do not like every person we encounter.

Fourth, do not take to heart if patient decides not to take your recommendations or advise. Sometimes, no matter how hard you try to convince them to do something, the patients will not listen. Acknowledge that our brain wants us to think that there is something wrong with us or there is a need to please the patients. No! Our recommendations are based on what we think is the best of the patient. Sometimes, it is simply just not a good fit between the doctor and the patient. Nothing has gone wrong. It is simply a human experience. No one on earth is liked by every single person under the sun, and it is okay.

The most important thing is to stay true to who we are. Remember our values. Be authentic to ourselves. Avoid doing things or making decisions which are not in alignment with what your beliefs are. This is not to say that we are not flexible or unable to make minor changes. We always get to course correct and fine tune within ourselves, so that we are becoming better than we are.