{"id":13877,"date":"2012-12-24T12:35:35","date_gmt":"2012-12-24T17:35:35","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=13877"},"modified":"2012-12-24T12:35:35","modified_gmt":"2012-12-24T17:35:35","slug":"when-the-doctor-patient-relationship-splits-up-boston-globe","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2012\/12\/when-the-doctor-patient-relationship-splits-up-boston-globe.html","title":{"rendered":"When the doctor-patient relationship splits up (Boston Globe)"},"content":{"rendered":"

\"Boston<\/a>In the Society for Participatory Medicine we talk about professionals and patients being full partners in care. And sometimes, as in any partnership, the two part.<\/p>\n

Have you ever “fired” anyone? Before it got to that point, did you express your concern (“I want to talk about something”)?<\/p>\n

In the In Practice column in today’s Boston Globe, Dr. Suzanne Koven of Mass. General writes When patients split from doctors the latter feels the pain<\/a>.\u00a0It’s a sensitive, nuanced piece, delicately touching on vignettes with no easy answers:<\/p>\n

I had been in practice about a month when I called a new patient to tell her that the lab had lost one of her blood tests. Not to worry, I said. We would repeat it at her next visit.<\/p>\n

\u201cThere won\u2019t be another visit,\u201d the young woman replied coldly. \u201cI told you my grandfather died of gastric cancer,\u201d she explained, \u201cand you did nothing to screen me for it.\u201d<\/p><\/blockquote>\n

<\/p>\n

I mumbled an apology, hung up, and walked down the hall to a more seasoned colleague\u2019s office. How could I have been so ignorant, so incompetent? How could I have failed this woman so utterly?<\/p>\n

\u201cWhat\u2019s the screening test for people who have a family history of gastric cancer?\u201d I asked my colleague. \u201cThere isn\u2019t one,\u201d he said.<\/p><\/blockquote>\n

See what I mean? A patient (apparently) tries to be vigilant about her health, and has a standard, and expresses it, feeling wronged. The doctor, far from shirking responsibility, feels bad and asks a colleague. And then it turns out, perhaps the reason she didn’t think of screening is that nobody taught her about screening because there isn’t<\/em>\u00a0any screening.<\/p>\n

(That’s speculative interpretation on my part, from reading the few words in the column. But it serves the purpose of illustrating the complexity of a relationship when there’s so much uncertainty in medical science.)<\/p>\n

Dr. Koven cites three ways to lose a patient, all painful: death, firing the patient (quite dicey, she says, with legal risks among other things), and being fired – sometimes amicable, sometimes not:<\/p>\n

Sometimes the doctor-patient relationship, like any relationship, just doesn’t click.<\/p><\/blockquote>\n

Ain’t that the truth!\u00a0Sometimes two people simply don’t mesh:<\/p>\n

I recall a new patient who spent the better part of his first visit telling me how insensitive his previous M.D. had been. When I glanced at his records I saw that my predecessor was a physician who\u2019d won awards for his extraordinarily compassionate care.<\/p><\/blockquote>\n

For heaven’s sake, what’s the tragedy if you’re just not a good fit? No doctor is starving for more patients to see. Heck, I know some patients don’t want to be participatory (they want to be told what to do) and some docs are that way. I hope they find each other and have a great life together.<\/p>\n

Personally, I’ve come not to expect perfection from anyone, not even the famed Dr. Danny Sands. When he doesn’t bring something up that I want to know, I ask. (Duh?) That’s what an empowered person does: knows what s\/he wants, and expresses it.<\/p>\n

Note that Dr. Sands is not shy about saying “I don’t know,” and I don’t interpret that as a failure: a million new papers are published every year, and as I said a year ago on KevinMD, Expecting doctors to be perfect is a setup for dysfunction<\/a>.<\/p>\n

Clinicians, patients, family members – what’s your experience been? \u00a0Have you experienced dialogs like the ones Dr. Koven cites? The whole piece is\u00a0here<\/a>. Perhaps most useful,\u00a0what have you found to be effective in building a good working relationship?<\/p>\n

__________<\/p>\n

btw, it drives me nuts that Globe pieces commonly have a different title in the print edition. I know headline writing is challenging – I used to do it, on the school paper – but in this case there’s plenty of room in both the print & online editions so the difference is puzzling:<\/p>\n