Medical Practice

As stated above, physicians must recognize that patients are not the equivalent of cases or diseases; they are individuals, whose problems often transcend the complaints they are verbalizing. They frequently are anxious and frightened when they visit their physicians and may try to convince themselves that their illness does not exist. They may even try unconsciously to divert attention from the real problem that they perceive to be threatening. At times, illness is used as a means to gain attention or as a way to extricate themselves from a difficult emotional situation. With this in mind, physicians need to view their clinical findings in a broader context involving not only the patient but the patient's family and social background.

Knowledge of the patient's origin, education, home, family, job, and goals is very desirable. It provides useful information that permits the physician to establish rapport with the patient and to develop a good insight into the patient's illness. Under these circumstances, mutual trust is developed and an open channel of communication is established.

The traditional one-on-one patient-physician relationship is changing due to the change in the setting in which medicine is practiced today. Frequently, when dealing with a serious illness, patient care involves a variety of allied health professionals, in addition to several medical specialists. A health team effort is therefore commonly mandated, which can prove especially beneficial if the primary care physician asserts a leadership position and maintains a special status in the patient's eyes. The primary care physician needs to retain the ultimate decision-making authority in the areas of diagnosis and treatment. This arrangement should also be in effect when medicine is practiced in a group setting, for it is the primary care physician who has an overview of the patient's problems and reaction to medications, as well as knowing the patient's response to his or her illness and to the challenges that must be faced.

The modern hospital can be an intimidating environment for most patients. Being confined to bed, surrounded by buttons, air jets, and lights, with one's body invaded by tubes and wires, visited randomly and at all hours of the day and night by members of the health care team—physicians, nurses, technicians, therapists, and aides—often stimulates a loss of a patient's sense of reality. This negative situation may be further reinforced by transporting the patient to X-ray departments or special testing and/or therapy facilities.

The primary care physician frequently serves as the pivotal link between the patient and reality. The stressful hospital situation can be somewhat ameliorated by a strong doctor-patient relationship.

There are a number of factors that lead to impersonalization of medical care. These include:

1. strong efforts to reduce the cost of health care;
2. heavy reliance on computerization and technological advances for diagnosis and treatment;
3. growth of health maintenance organizations (HMOs), which may not allow patients to select their physician;
4. need for more than one physician to be involved in the care of seriously ill patients;
5. increased mobility of physicians and patients;
6. increased frequency of litigation by patients to express their dissatisfaction with their physicians or treatment or results.

In the light of this medical climate, it is especially challenging for physicians to maintain a humanistic attitude. It is now even more essential that each patient, regardless of personal circumstances, be treated carefully and courteously. This means that the physician-patient relationship needs to be built on a foundation of respect, integrity, and compassion. The level of communication between both sides should allow the patient, to the fullest possible extent, to gain an understanding of the nature of the illness, the treatment protocol, and prognosis.

In dealing with patients, the physician should avoid being judgmental of their values and lifestyles unless it is medically relevant (for example, smoking and alcohol or substance abuse, which should be firmly discouraged). In the course of one's practice, every physician can anticipate meeting patients who evoke negative, as well as positive, emotional reactions. Physicians need to be aware of this possibility and should not allow their judgment or actions to interfere with their patients' best interests.

In order to treat a patient effectively, a good relationship between physician and patient must be established. This mainly depends on the empathetic response on the part of the physician and recognition of the physician's caring attitude by the patient.