Expectation in Medicine
In my previous postings on the angry patient, I think much of the etiology of the anger is related to the simple and common psychologic activity of expectation. We all generally go into a medical relationship, either as the patient or the physician, expecting something good to come out of it. But as Emily Dickinson seems to be warning us, expectation, though anticipated as satisfactory may lead to, one might say, unexpected consequences.
”Expectation—is Contentment” by Emily Dickinson
Expectation -- is Contentment --
Gain -- Satiety --
But Satiety -- Conviction
Of Necessity
Of an Austere trait in Pleasure --
Good, without alarm
Is a too established Fortune --
Danger -- deepens Sum --
What is being expected in medicine? From the patient’s viewpoint, it is having a pleasant and empathetic and conscientious physician who has the knowledge and skill to treat satisfactorily the illness. Additionally, the physician is expected to take or make the time to listen to the patient, perform a proper examination and communicate in way that the patient understands the diagnosis and the recommendations. The physician’s office must also reflect the same personal attention that is being provided by the physician. I think that these qualities are something which most patients expect.
What is being expected from a physician’s viewpoint? I think doctors want the patient and the family, in general, to be tolerant regarding the limits of medical practice in the 21st century. That they should be realistic and therefore be understanding and supportive of the issues the physician faces with regard to office management as well as diagnosis and treatment management. Specifically, the doctors want an educated patient or one who can be easily educated in personal medical matters and desires to be compliant. They want a patient who presents with a problem that can, even if challenging, be managed by the physician to the benefit of the patient.
Unfortunately, for both parties, expectations may never be fully realized to the anguish of each. To the patient, in many ways, if the physician fails to meet the patient’s needs, the resulting discomfort adds to the burden of the illness itself. To the physician, if the patient, the family, the disease or the response to treatment fail to be the hoped for ideal, personal or professional confidence may be lost and the physician may project the loss toward the patient or family. And so with expectations by one party or the other or both, not leading to that “contentment”, the relationship deteriorates and display of the discontent including anger in one form or the other may appear.
What do you think a patient or a physician expect out of their relationship? ..Maurice.
posted by Maurice Bernstein, M.D. @ 9:13:00 PM
2 comments
2 Comments:
"[patients want a] physician who has the knowledge and skill to treat satisfactorily the illness."
Agreed, but doctors need to be willing to openly admit when they are out of their clinical element and refer to someone more equipped[1] to handle a problem when it gets too complex rather than stubbornly holding on too long. The flip side of the same coin is for a patient to understand that when a physician says, "What we are doing hasn't been working, and unfortuantely in the meantime, some things have gotten worse, so I'm going to send you to [so and so]," that it isn't a reflection of incompetence or "giving up" on the part of the physician.
Patients need to understand that doctors have limits imposed by knowledge/specialization, time, and Nature Herself. Doctors need to remember that most "angry" patients are usually angry becuase of bad communication (hence expectation management), not because of genuinely bad treatment.
Just my novice $0.02...
--ec
[1] This of course, excludes the ubiquitous CYA referrals that are made for legal reasons, not sound clinical ones.
I agree that some physicians have a degree of inappropriate "self-confidence" which may prevent appropriate consultation.
But you know, Enrico, that most likely the underlying reason most "CYA" referrals "for legal reasons" are made is a clinical one: the physician's clinical uncertainty. Two physicians agreeing on a course beforehand may not prevent a law suit being filed, whereas ,in court, an expert witness supporting the standard of practice of a defendent physician, I think, will be much more effective in turning the case in favor of the physician. ..Maurice.
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