What Kind of Doctor would You Select to Be Your Doctor?: Engineer, Priest,Colleague or Contractor?
I put this question up as a Question on Medpedia but would like to also present it to my visitors here. You might go to Medpedia and look at any responses but also access the link below and then return and write your comments here.
The ethicist, Dr. Robert Veatch in an article” titled “Models for Ethical Medicine in a Revolutionary Age" published in the Hastings Center Report 1972;2:5-7.has set these 4 possible models: engineer, priest, colleague or contractor for society's current and/or future view of the relationship between the doctor and the patient. A review of these four models is nicely written by E.C. Hui MD, PhD (Medical Ethics Unit, Faculty of Medicine,University of Hong Kong, Hong Kong) and can be accessed at the following link: http://www.hkmj.org/article_pdfs/hkm0506p222.pdf
What do you see as the ethically good and the bad with each of these models? If you had only one to select, which would it be? ..Maurice.
What do you see as the ethically good and the bad with each of these models? If you had only one to select, which would it be? ..Maurice.
posted by Maurice Bernstein, M.D. @ 5:03:00 PM
9 comments
9 Comments:
Hi Mo - It's been awhile.
Though I probably would emphasize different features of the physician's role than either Veatch or Hui, the engineering model is the one with which I'm most comfortable. If a physician competently explains alternative courses of action, along with their attendant risks and likelihood of success, I think I'm able to make my own choices. As an aside, not really relevant to concerns about the interpersonal dynamics of physician-patient relations, in my experience, the best physicians from a technical perspective (i.e., skill in diagnosis, prognosis and therapeutics), came to medicine from an engineering background where "problem solving" is the name of the game.
Bob, I'm interested. What specific "different features" would you have selected for the physician's role? The four models seemed to me rather all encompassing. ..Maurice.
Dr. B,
I think we've had this conversation before in another thread.
As an engineer, my preference is for the informative/engineer model - big surprise, eh?
What I want from a physician are the facts and technical information that I need to allow me to make my own decisions. I expect them to cover all alternatives and the pros and cons of each without bias towards their preference or recommended approach.
As an engineer, it is my responsibility to my client to assess the situation at hand, analyze the data, and provide he client with an explanation of the results of and the statistical reliability my analysis and a list of possible actions, with the pros and cons of each. It's up to the client to decide what they want to do.
This is what I expect from a physician - no more, no less.
Bob and Hexanchus, technician fine, autonomous decision fine, but don't you both want a humanistic technician and doesn't that require something further in the doctor-patient relationship? ..Maurice.
My main concern when I seek the help of a physicisn is what I've referred to as technical skill; in diagnosis, prognosis and therapy. I recognize that to do this effectively, well developed interpersonal and communicative skills on the part of the physician are often needed. But that suggests that these skills are subordinate to the technical skills mentioned. Of course, I appreciate being treated with kindness and sympathy and respect -- but I appreciate that generally, whether I'm dealing with my neighbor or my physician. As a patient with a medical problem, if I had to choose between treatment by a technically competent "jerk" and an incompetent "saint", I'd opt for the jerk every time.
Dr. B,
I don't see that they are mutually exclusive. Good communication skills are essential to almost any professional. Given the choice, certainly I'd want a physician with both. But as Bob said, if I had to choose, I'd take the technically competent jerk over the incompetent nice guy....but I would still make the decisions.
Correct me if I'm wrong, but I believe you are referring to the efforts some medical schools have made to integrate humanistic medical teaching into their curricula to try to pull back from what has been an overemphasis on medical technology to the detriment of individual patient care. In essence, a patient is first and foremost a human being, not just a disease or condition. I applaud this approach, and hope it helps reverse the depersonalization of medicine that has occurred over the last couple decades.
Hexanchus, yes we do. We tell the students that there isn't a "gall bladder in room 210" but there is "Mrs. Mary Smith in room 210". ..Maurice.
long time no talk ...
i want it all! a good professional always has more than one side to her or him. my main medical professional for the past 5 years has been a nurse practitioner; mostly i want her to be a well informed health co-manager but i'd also like her to have the patience and compassion of a priest. for my dental problems i'd LOVE to have someone with more of an engineering mindset but if they don't understand that my fear of dentists can crop up again any moment (the priest again) they're worthless to me.
why not educate medical students in all ways? one of the most useful courses i've taken in psychology was a history and theory course where we had to look at a psychological problem from the point of view of numerous theories.
Whenever this issue is discussed the same false dichotomy gets posited -- competency vs decency. As if being a malignant personality or socially dysfunctional implied competence, or vice versa.
In reality, somebody who lacks empathy, is a poor listener, or takes a reductive approach to problems is likely to be inferior both in the social and the scientific challenges of medicine.
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