Last week a forum called "Healthcare Reform: Putting Patients First" was held in Washington, DC. A distinguished panel of experts was tapped to speak: primary care doctors, specialists, a congressman, and a "policy expert."
Notice anyone missing from the panel?
Uh-huh. No patients.
Oh - there were patients in the audience, and I understand they were quite vocal and had an opportunity to make some comments, however....
Prior to the event, the fact that this panel had been put together sans patient-presenters created a stir among those of us who advocate for patients. We wondered how we could have been excluded? Can you imagine putting together a program called "putting doctors first" -- and not including doctors?
Dr. Rob Lamberts, whose praises I've sung previously on this blog, wondered why we patient advocates would be upset at being excluded from the panel. After all, he said, "Doctors are patients, too!"
But I disagree. I don't think doctors can ever be "purely" patients, because no one can ever subtract their medical knowledge. Just like you can never understand what it's like to be illiterate -- because you can read this blog, no one can ever subtract your ability to read -- you can never be "purely" illiterate.
Dr. Rob suggested that a better metaphor would be a social worker who works day-in and day-out with poor people. He asked, couldn't they be trusted to speak from a poor person's perspective? I say no -- they can't. They have never been homeless and they have never been hungry. While they may be good advocates for the poor (as doctors may be good advocates for patients), they will never truly understand a poor person's point of view.
In fact, I believe it's somewhat condescending to even suggest that would be true. To suggest that we "mere" patients cannot speak for ourselves, that we need a doctor to represent us, is more paternalism than it is respect.
What do you think? Do you agree with Dr. Rob? Can doctors clearly understand and speak from a patient's point of view? Or do you agree with me -- that we patients have a perspective that is different because we've never had a medical education. We deserve the respect of having our own seat at the table.
Please take this poll. Then comment here if you have more to say.
By the way -- I followed the conversation as best I could from afar. Most of the speakers did a credible and fair job from their own perspectives. But that policy expert? -- a shill for his patrons, the pharmaceutical industry -- clearly not living on the same planet as the rest of us.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Learn more or join the conversation!
NEWSLETTER |
FORUM |
BIO |
TWITTER
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Photo of Congressman Paul Ryan who participated in the program © Brendan Hoffman /Getty Images
I’ve had several doctors, most of which stayed firmly in the “doctor” role. But there is one exception, a man my age who has many life experiences similar to mine. He listens well, sympathizes, empathizes, and gives me some of his own personal solutions. He is clearly the exception, and is my doctor of preference. The others may be patients, but don’t live, act, or get treated that way – especially by other doctors!
I voted NO but in reality I feel there is at least some gray area. Except for the fact that he is rushed, and that he is obligated to play the CYA game, I am able to talk to to my dr in a way that suits me. (Please note, I have to drive 1.5 hours each way to find such a physician…) I like to keep my medical activities as holistic as possible, and this doctor is into that, and is also very well trained as an MD. But even so, I still find myself figuring out what my symptoms will respond to without his help.
The kindest, most compassionate, yet most effective doctor I had was one who himself had suffered from chronic kidney disease all his life. He told me about being a patient in the hospital during his own medical residency, and how ‘challenging’ he thought being a patient was.
He had a heart valve replaced and later was on dialysis. He spent ‘real time’ as a patient.
Perhaps a doctor like this can also say “I’ve been a patient, too”.
Sadly Dr. Edward Prokipchuk passed away 3 weeks ago, and his passion and support for patients has been silenced.
We lost a true doctor/patient.
Docs are insulated by their education and their position in healthcare. They don’t fully understand patients as people (even the docs that are our favorites don’t completely get us). I think docs that have patient experiences have more empathy for their patients later, but to say that doctors are patients, too, just because they are human is not even kind of accurate.
When a physician gets sick, he or she is not going to enter the healthcare system the same way an unconnected patient will. The doc is going to call up a colleague for a referral or a consultation.
When I get sick, I rely on my primary doctor to be my “general contractor” so to speak. He is responsible for coordinating specialists and medical testing, the “subcontractors” that do all the work. So just like when a contractor decides to build his own house and handles all the subcontractors himself — to lay the foundation, frame the walls and put on the roof — a doctor coordinates his own care and is treated with the same respect and professional courtesy that carpenters reserve for plumbers.
The respect that being in the same group cannot be removed from the relationship — and is not present in the vast majority of the patient population.
As a physician, I don’t think we can’t speak from a patient’s point of view from step 1. It has been portrayed that when a physician is diagnosed with a disease, he or she enters the realm of being a typical patient, but that is not usually the case. In my own care, physician colleagues spend much more time with me explaining intricate details and interpreting studies in a way I am sure they don’t with everyone – they wouldn’t have the time.
We tend to enter the system from a different angle as well. Rather than making an appointment and waiting… many of us “curbside consult” colleagues in the doctor’s lounge or hospital corridors asking who they would recommend we or our families see for such and such a condition.
And while many patients are considering whether they should get a second opinion, many of us in medicine have already gotten second, third, fourth, and fifth opinions, just through our conversations with physician friends on the phone and in hospital and clinic hallways.
How could we begin to understand?
Definitely not, in the majority of cases.
Rod, you hit the nail on the head.
If you’ve every witnessed the socialization of doctors up close, it is clear that doctors are trained to view patients as “bodies” rather than people, people who have a voice and who are legitimate stakeholders. A friend of mine went to medical school lossed her empathy for other people.
The fact that one of the doctors at this conference, who according to their social strata is a higher up, would defend a “putting patients first WITHOUT patients and not see the hypocrisy tells you pretty clearly that the enculturing effect of medical school to de-humanize patients is pretty effective.