Professor Wolpe described the complexity of the clinician-patient encounter, underlining a myriad of important factors/dimensions that play into this dynamic. At the same time, he reported that – typically – it is only really a matter of seconds after a patient sits down with a clinician that he/she is interrupted and the clinician recasts the patient’s narrative. Can this realistically be resolved?
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Based on my prior experience with clinicians there were times where I have been interrupted and felt rushed to answer their questions. Then the clinician would give me a recap of what I said, and it wouldn’t be the same thing. I would often leave the clinic feeling like I wasn’t given the help I need. On the other hand I have also been to other clinics where I was also interrupted by the clinician but it was to ask questions or get clarification on my narrative and they would be taking notes while I was talking. During those visits I felt that my issues were heard and that I was prescribed correctly.
Due to these experiences I believe that this problem could be realistically resolved, it is just a matter of the clinician wanting to thoroughly listen to the patient. I feel that clinician interrupts and recast because they are rushing and trying to get through as many patients as possible, but they might not realize that by doing that they may be setting themselves back instead of forward. This is because the patient may not have been given the correct diagnostic and therefore they must return again to be treated. If instead the clinician listens attentively to the patient, waits until they are finished then asks questions then it may take a bit longer but they will be helping them much more. Also if the patient feels that the clinician isn’t understanding them or is recasting their narrative, then they should speak up and let them know. It is understandable that the patient may feel intimidated to correct the clinician but if they do not speak up it is their health that will be jeopardized. Overall this problem could be realistically resolved whether it be that the clinician takes more time to listen attentively to the patient and then ask questions, or that the patient corrects the clinician when they begin to recast their narrative.
The current set up of the American medical system will make it nearly impossible for this issue to be resolved; American health care is a largely profit based entity and we will hence not see a system in which doctors routinely give patients the opportunity to tell their story until we see a system which focuses less on quotas and gives doctors ample time with every person who steps into their office.
I agree with Jennifer’s assertion that the problem stems from physicians not thoroughly listening to patients in an effort to move as fast as possible and see a large amount of people in a given day. The principle of holistic medicine stresses treating the patient like a person and not a disease; communication is a crucial component of this approach – by giving a patient time to tell their personal narrative the doctor implies that the two are equals and are working together to solve a problem. The benefit to this is two fold as it fosters a sense of partnership between the two individuals who also brings valuable information to the table that would not be readily available if the doctor assumed a dominating role. The two parties both have a unique knowledge base that, when combined, can provide a cure more effective than what would result with the two parties working separately. In an ideal world physicians would give all patients ample time to tell their personal stories as it allows the individual to maintain a sense of personhood throughout the medical process and also provides information that could prove crucial to the development of a cure or remedy.
Giving a patient ample time to tell his story is an important component of moving away from a paternalistic approach to medicine. However even if a doctor readily acknowledges their practice is negatively affected by spending a lack of time with a patient there may be very little they can actually do to fix this matter. Unfortunately many aspects of how medical personnel operate their practices is outside of their control; higher up powers set quota for how many patients a doctor must see in a given day, which affects the length of a visit which in turn makes it nearly impossible for a patient to get out his whole story. Doctors often form heuristic models regarding a patient’s ailment involving a variety of personal data for the individual such as cultural background, social class, race and gender. These models are often developed to save time, as the doctor feels like he can form an adequate understanding of the patient’s background without wasting precious appointment time. They often subconsciously consider these factors when making diagnoses; these factors can hence lead to prejudices that affect the quality of the patient-physician interaction and ultimately prevent the patient from receiving the care that he needs.
While it is very important for a patient to be able to communicate with his physician, doctors are first and foremost medical professionals with the primary task of implementing biomedical care. Therefore in a time-sensitive system that makes it impossible to conduct a completely thorough investigation of the patient’s problem, it is completely understandable that a physician may chose to sacrifice a component of the process that they do not deem absolutely necessary. While this is an unfortunate reality that hinders the practice of collaborative medicine, it is an unavoidable byproduct of a medical system that places such harsh constraints on the amount of time a physician is allowed with each patient. Therefore I assert that while patient-physician collaboration is an imperative part of effective medical practice, it can not realistically be implemented in a medical system such as ours which places so much value on the amount of patients a doctor sees in a given day. If we truly are to provide patients with a means to tell their full narrative to their doctors we must establish a medical system with the primary goal is not to make a profit but to care for patients.
I agree with Jenny that the essence of this problem lies in the time constraints a clinician feels she or he needs to operate in in order to reach all their patients for the day. Not only do the interruptions provide causes for a patient to get irritated (subsequently disrupting a harmonious doctor-patient relationship), but also may cause the physician to have an inaccurate account of their patient’s case. If the patient cannot trust their doctor to hear them out, they may not feel like speaking up about their injury or illness or even their concerns over treatment plans. The doctor may never even hear about the socioeconomic factors that might be the cause behind a patient’s long term illness. Clearly, interrupting and recasting a patient’s narrative is cause for concern when one considers the long term consequences on the clinician-patient relationship.
As for whether this can be realistically resolved: yes and no. It ultimately depends on the clinician to come to the realization that they are not taking their patient’s circumstances into account. For clinicians who are operating in the current system where time is of the essence and physician shortages pose huge problems, I doubt many would be able to come to this realization on their own. Personally speaking, I feel if you care enough, you can make time to wait, jot down a few notes, and ask your questions when someone is finished speaking. Again, I feel education is key when it comes to resolving such problems; there are various medical conferences where this problem could be brought up and addressed.
From some of my volunteering experiences, I know some hospitals have courtesy rules set for staff taped behind their desks as a reminder (I believe we heard in class that hospitals that have these rules set tend to be better received by patients). These courtesy rules shouldn’t extend to just nurses or welcome staff alone, but also to clinicians (who shouldn’t feel like they are above the system just because they are doing the diagnosing). I feel that this problem of interruption is more of an issue for doctors in the current system.
Another way to tackle the issue of time shortages is simply to increase the number of students entering the field instead of limiting numbers to a select elite; if we increase the number of up-and-coming physicians, we can alleviate the problem of physician shortages and the time constraints with patients. The up-and-coming doctors, residents, and medical students can be expected to nip the problem in the bud for the future. Educating medical students on ethics, the multitude of factors behind illness, and the proper expectations for their bedside manner can really help in the long run.
I agree with Kristine, the set up of our medical system will not allow this problem to be systematically solved. While there might be a handful of doctors who pride themselves on taking the time to know their patients and see them as an entire person, this is far from the case for the overall healthcare system. Doctors have always been taught to look at the symptoms and go from their to a diagnosis and not from the standpoint of circumstances to diagnosis; it is this flaw in medical education that will not allow this. And while their is the complexity of the clinician-patient encounter, there are some outside factors that continue to be detrimental to fixing this problem.
And as we presented this week, we must also find a way to change the behavior of our doctors. Medical Schools need to look for more well rounded candidates, not to say that they should loosen their standards, but they need to accept students that will not only be good automaton physicians but caring caregivers. We must also increase access for physicians into the medical fields and supply more into fields where there is legitimate need of doctors rather than having doctors follow the money into plastic surgery or family medicine. We must provide more physicians where they are needed and take care of their livelihood as well as their patients. Because at the end of the day if we cannot take care of our physicians how can we honestly expect them to care for their patients?
The way that pharmaceutical companies run the healthcare system is obvious, just look at the effect that they had on the Affordable Care Act. With their lobbying and marketing power there seems to be no hurdle that they cannot overcome. Doctors are increasingly relying on instant fix medications to move more and more patients through their offices not only to help them but to be reimbursed for the prescriptions that they are writing. This current dynamic of medicalization of every problem that comes into a doctors office is one of the largest facts hindering a holistic clinician-patient interaction and is why I believe that this can not be solved until our healthcare system is revamped and power is taken from big pharma and given back to patients
Solving this issue may be beyond what we can do. I thoroughly appreciated the Venn diagram that Dr. Wolpe presented in class detailing the various social/personal factors that influence the clinician-patient interaction. Even though both sides share many similarities, it is interesting to still see how both sides fail to personally connect and understand each other.
Tying this week’s presentation theme to blog discussion, bioethics can partly explain the root of this failure of clinician-patient connection and communication. Bioethics encompasses a more interdisciplinary evaluation of issues that arise in healthcare.
Without a doubt, medicine and the process of patient care are messy task. When we throw socioeconomic, cultural, personal, anthropological, and religious factors into patient care all into one test tube, patient diagnosis becomes exponentially more complicated. Decisions about how to treat the patients becomes blurred, and given the structure of our healthcare system, precious time is ticking. In short, I can understand why healthcare providers often feel pressured to expedite patient care.
This is certainly a problem, as Courtni and Matthew briefly shared a brief presentation about the mental well-being of physicians who are constantly immersed in a stressful work environment. In concurrence with Matthew and Akanksha, we should find more compassionate physicians and allow for more students to enter the medical field. This however is easier said than done. The pre-med culture now has converted a lot of medical school requirements to checklist, and the constant pressure of needing to do well in a stressful environment has already grabbed a hold of many future leaders. This culture is certainly hard to break.
Ultimately, again, this is why I believe it is unfortunately unrealistic to solve the clinician-patient interaction problem, as the problem takes root in a bigger picture of healthcare.
As Jenny and other peers have expressed, a large part of the issue lies with time constraints in the healthcare setting. The healthcare provider and patient are not given enough time together. However, I would go even further to say that the problem is quickly becoming endemic within our society. We are orienting our society around speed and efficiency over quality and understanding. Doctor’s offices, fast food, drive-in chapels, instant movie downloads – the list goes on. I don’t know to what extent I can simply blame the healthcare provider who doesn’t seem so interested in me as in fulfilling a quota. It is very rare to have a conversation with someone who truly listens. We interrupt and ask questions. We want to get to the bottom of the story as quickly as possible. Often, we half listen as we multi-task. Our society is shaping this behavior and as much as we hate it in the clinical setting, it isn’t so different from our day-to-day.
That being said, I agree with Kristine that the structure of our medical system is the underlying barrier that will keep us from resolving these communication problems. Physicians are given more incentives to treat than to prevent illness and with so much pressure to see as many patients as possible, we have created a monster. Physicians, with little time to spend with a patient, must utilize their time as effectively as possible to solve the issue at hand. The mindset is the patient is here for a reason, I must get to the bottom of it and fix it.” This system, however, is largely inefficient as it overlooks causes and underlying problems in a person’s health. Had the physician taken time to note that the patient has been in and out repeatedly for the same problem or listened to the patient’s story they might have been able to prevent the illness from recurring or prescribed a habitual remedy as opposed to a pharmaceutical one. Our healthcare system was built on the need for fighting infectious disease and emergency care. As a result, America has one of the best emergency care systems in the world. But, now we have an increasingly aging population who needs preventative care and we are not equipped to handle it. If our healthcare system was based more on preventative care, then the communications issues we have been discussing would largely go away on their own, but until a restructuring occurs I don’t see it realistically getting any better.
Unfortunately, I do not think this is something that can realistically be resolved- at least not on a larger scale. I definitely agree with Kristine above that our system is not set up in a way that will support a change that will allow more time for the patient to tell their story. While we all seem to agree that it would be best for the patients and helpful in correctly diagnosing patients, I do not see this becoming a systemic change. I do think it is possible, and some doctors will make an effort to take a more holistic approach to treating their patients; including giving them the opportunity to discuss their current medical experience without interruption. However, considering how many factors contribute to the end result of treatment, such as the healthcare professionals themselves, the department, the policies of the hospitals in a specific state, etc., it will be more realistic for some healthcare providers than others.
Many of my colleagues mentioned above that America’s health system has become more emergency medicine oriented than preventative. When you look at the focus of our healthcare system, it makes sense why we are experiencing this issue. I doubt there is ever much time to sit down and talk with a patient in a traumatic or emergency situation prior to the procedure. If physicians and healthcare providers are taught to manage these situations more than preventative measures, the importance of communication is covered by the quick thinking, emergency methods emphasized by leaders in the healthcare field. These techniques then follow healthcare providers to other realms, where communication is indeed possible. However, after being taught to react as quickly as possible with less of a focus on communication, we end up in the position Dr. Wolpe explained in class: interruptions and a lack of communication in situations where it is possible and necessary.
I personally think it can be done and resolved, but it will take some time, mainly because of the reins in which the current medical model holds over students and how it affects the patient-physician dynamic. As well, it will also take some deconstruction of the systems in place that support/anchor people and hurts/harm others.
A lot of good points have been raised – physicians should, ideally, make the time and effort to get a good perspective on their patients. They should ask questions, while not prying and being invasive, and allow their patients to tell their story in its entirety and make sure that their patients leave their office a bit closer to a more optimal state of health. A partnership should be fostered to make sure the doctor is providing the services the patient needs and rightly deserves, even if that interaction is limited to one conversation.
However, as Matthew and I brought up in our discussion lecture this week, there are factors of intersectionality and ethics that pervade this interaction that many in the medical field may not be “savvy” to. Just as we talked about disability and privilege, as some students pointed out, medical students are well-educated, high-achieving and high caliber individuals because of the selection system that the medical world utilizes – yet, the casted net is not as diverse as it could be. It’s for good reason to supply and support a force of physicians that is at the top of the class and can provide the best care, but can a MCAT score and a few hours of volunteering really dictate that though? Are we really allowing every kind of individual the ability to be a doctor and are we making sure we aren’t silencing those who need to be heard? Race, gender, sexuality, SES, personal/familial background and other contributors of an identity that make a person affect how interactions go – in order to reach a point where mutual respect and professionalism are maintained or enforced, we have to address the problems within other systems that sociology, psychology and many other disciplines have brought up. Intelligence is important, but the definition is variable for a reason because there are different kinds of intellect and there are different kinds of people – thus, we need to constantly address how we view medicine, choose our doctors and train them in a system that allows this. Because, as it was mentioned before, for example, there are very few doctors with disabilities – while that may not mean that every patient with a “disability” can be only helped by someone with a similar disability as themselves, it sends a silent message of what “normal” is. And it highlights privilege – in that, there is no denial that people work hard and try their very best, but it highlights that some people may not ever experience certain things or have to face certain problems, conditions or standards and that can affect how interactions go. Assumptions can be made, dialogue can be silenced and people can get hurt, but unless the underlying systems aren’t addressed, it may be creating the same system with a different name. In addition, presenting physicians and those who are chosen to be physicians of tomorrow as a certain image or ideal can be problematic in reinforcing how doctors are seen and heard. It also stigmatizes those who don’t fit the mold, which has consequences.
Therefore, I think one way of addressing this problem is by medical students, physicians and healthcare professionals being more interactive with the humanities and other disciplines in a collaborative manner to foster a relationship that supports “humans”, not reducing people down to the illness they have – if people see their patients as humans like themselves, a relationship can be fostered rather than start the power struggle that can develop because of how doctors can be seen as “Gods”. I also think that changing the way pre-medical culture is can be helpful, because while some can argue that having the smartest doctor is important, it’s also nice to have a doctor who can really understand where you’re coming from and has people skills to not speak “medicalese” – I think that kind of culture isn’t reinforced to students who choose to follow their medical calling. I also think it’s important to address the ethical and realistic concerns that go into medicine in order to make students more aware that they need to be “aware” – medical knowledge is important, but it cannot replace understanding the socio-historical consequences of Tuskegee or being able to explain why knowing gender inclusive terms like “transgender” or “bigender” are relevant for more inclusive conversations on healthcare. It seems overwhelming because of the systems in place, but it simply takes encouraging everyone to be a bit more thoughtful, to change the systems we have, and to deconstruct things in a way to support a better model that not only alleviates the mental and physical strains on patients, but also on doctors as well.
In my experience as a patient in the clinician-patient encounter, some health care professionals are better at listening than others. When I went through the whole process of getting braces, I remember that my orthodontist, who was a genuinely nice man, was from Long Island and he spoke so rapidly that I could barely understand what he was telling me. Sometimes I would start to tell him something and then immediately he would jump in and assume he knew what I was going to say. When I was having my wisdom teeth removed, my experience with the oral surgeon was completely different. I remember feeling those nervous butterflies jumping around in my stomach since this was my first procedure during which I would be sedated with anesthesia. However, as soon as I entered the office, the doctor was very friendly and clearly cared about listening to what I had to say. He took the time to explain the whole procedure in plain language, the potential side effects, introduce himself and his assistants, and then ask how I was doing and if I had any questions or concerns.
While it was a much nicer experience as a patient to have my doctor take the time to listen to what I had to say and my story, I realize that in the current health care system it is extremely difficult for every physician to do this. As Jennifer and others have mentioned, there is the ever-present time crunch and push to see as many patients as possible. When it comes to treating patients, quantity is emphasized over quality of care. To remedy this lack of quality care, Akanksha brought up a key point that more students should be admitted into the healthcare field. As Dr. Wolpe mentioned in his lecture, only the best of the best students are admitted into medical school. While it is important to ensure that prospective physicians are well-qualified, we need to recognize the dire need for more physicians and healthcare professionals.
Just as clinicians should focus on quality over quantity of care, medical schools should admit more students while working on training their students to be compassionate and communicative healthcare professionals who know how to listen to their patients. To realistically resolve the issue of clinicians failing to fully listen to their patients, medical schools have to start teaching ethics and bioethics to their students. As we have discussed in previous classes, communication is essential to improve quality of healthcare. If clinicians can learn to communicate with their patients more effectively by listening to them for even a minute or two, then patients will feel more completely cared for.
As many have pointed out, time is the big constraint on this, and the limitations of the health system. In my own personal experience, I know my doctor at home charges anyone who is late or no shows, and not that I have am entirely opposed to this (if you make an appointment, show up) however, his explanation was a little troubling to me. My doctor was explaining how much money they lose annually on no shows or late patients, and I wanted to retort back what about the money lost by patients for expedited doctor visits, but I restrained myself. Yet, as he has been my doctor since I was 11, we have a pretty good relationship in which I tell him many things that are going on in my life that could affect my health. But, as I think about it more I realize he does not really know me, just my actions. And as others have pointed out I can count numerous times I have started to describe a health narrative, and he interrupted to lecture and tell me what steps I should take next before I even got to the emotions I had about the issue. So, in eleven years my doctor really does not know me, just my actions, however he would more than likely say he does know me. How does one change this? Many have pointed to the solutions of forced learning of ethics and sociology in medical school, and while yes this is necessary, how to implement it properly remains the key question.
I do not believe that the issue can realistically be resolved. While we have seen cases of hospitals that have improved their interactions with their patients, I do not believe that the clinicians will ever fully listen to the original narratives of the patients – at least not on a country-wide scale. Similar to Kyle’s situation, I’ve known my doctor since I was very young. Our families are old family friends. However, unlike Kyle, I feel that my doctor actually knows me. I realize that this is because I see my doctor outside of the hospital setting very often. I also realize that this is an exception, and not a rule to how people usually have relationships with their doctors. In my experience, I find that my doctor doesn’t necessarily change what I say, but she does tend to cut me off. It is my understanding that she is trying to frame my symptoms as I go along. So if I say something that may not be completely clear, she interrupts me and asks a a question to get a more specific answer out of me.
After realizing that my situation is out of the “norm,” I believe that the issue is too ingrained into the healthcare system and too complicated for it to be completely fixed. As my peers have mentioned, time is money in healthcare. Doctors are on a tight time schedule that they must keep to, or else they miss out on the money they would receive when seeing other patients. While I do not believe that the doctors are pushing the speed of the visits, I do believe that they are punished by the hospital administrators if they do not keep up to speed. The changes need to come from the top down if we are going to see any true change in the patient/provider narrative.
I must echo the sentiments of my colleagues, for the various factors influencing the patient-physician relationship pose too great of difficulties to resolve the issue of physician interruption overnight. For example, the fee-per-service financial arrangement of the healthcare system in the United States encourages physicians to see more patients in a day and consequently spend less time in each examination. As a result, one would expect that the physician would dominate the visit in order to deliver necessary information. In order to combat the interruptions due to the time restraint, the system should require a greater length of time for the patient-physician encounter. Therefore, the physician would not feel inclined to interrupt the patient, and the patient can tell his or her full story. In addition to the financial arrangement of the healthcare system, cultural factors can influence the dynamic as well. For instance, a physician may not understand the word choice or language of the patient, so he or she may decide to facilitate the discussion for efficiency. For example, rather than trying to decipher the story, the physician can recall the story from his or her own perspective to ensure correctness and then proceed with diagnosis. Furthermore, the paternalistic mentality of medicine in the United States exacerbates this patient-physician phenomenon, because the physician assumes a position of superiority. For instance, the physician can just read the test results or the intake information from the nurse and progress to stating the problem and proposed treatment options rather than “wasting” his or her own time by listening to a story that reflects the information in the medical chart. Moreover, as some of my colleagues expressed, trainings could improve the patient-physician relationship. For example, training on cultural competency, although not inclusive of all cultures, could help a physician navigate discussions barred by word choice or beliefs about etiology of disease. In addition, officials or professors could stop teaching reflective language training. When using reflective language, physicians use the words articulated by the patients as a way to echo and clarify the situation or complaints. Although the aforementioned technique usually applies to the encounters between sexual abuse victims and physicians as a way to create a comfortable environment, perhaps physicians are using this language in other situations as well, perhaps accidentally. Therefore, physicians should remove reflective language from the medical context, and only counselors should engage in such communication style. Thus, although difficult, various trainings could contribute to the resolution of the physician-interrupted encounters between patients and physicians.
Time constraints placed on doctors seem to be the most common theme, which impacts the clinician-patient relationship. In the current system, patients want to be heard and unfortunately, some doctors are quick to reinterpret the patient’s story in order to make sense of the patient’s problems and prescribe a treatment. Others are quick to ask clarifying questions, like MacKenzie stated. I have never felt rushed or pressured to hold back my narratives by my long-term pediatrician. However, I recently visited a new optometrist, whom I thought was very frustrating to work with. My old optometrist was open to listening to my concerns, and did not perform any tests when I denied them. My new optometrist was quite stubborn, and despite my history of contact lens usage, refused to give me my lens prescription even after a week of trial wear. She insisted that I come back again to triple check that these contacts, which I have been wearing for 8 years now, were the correct type. Additionally, she performed a dilation on me after I specifically told her I did not want it done because of the extra fee, and I did not feel that it was necessary because had recently done one already, and could have easily sent my reports to her via fax. My experience with her was the first time I felt first-hand, a lack of patient autonomy.
For this dynamic to be resolved and result in a more equal interaction between the patient and the clinician, there needs to be a change in both the way doctor’s perceive their roles, and the lack of allowance for more time with patients from the overall health system. Realistically, I do not think this can be solved fully. If any improvements are made, it will be a slow and gradual process. While training on compassion have the potential to create greater awareness about the importance of compassion and communication in the doctor-patient relationship, it needs to be practiced and applied on a daily basis. It needs to become a widely accepted expectation for patients to share their narrative, and for doctors to listen and understand their values, ethics, perspectives, and cultural influences. A medically-oriented history is not enough. Patients and doctors are human. Both need to accept that neither are right nor wrong in the face of a misunderstanding. Working together as a team, and from the bottom up, like MacKenzie suggests, is vital.
I don’t believe clinicians do it out of malice, but they do have a tendency to place their ideas of the symptoms of the disease onto the patient rather than taking the time to listen and understand what’s going on. Like everyone said, its most likely because they are trying to help get to all the patients in the waiting room. If they could sit and understand everyone’s predicament, small or large, someone else may be put at jeopardy, especially if their ailment is time sensitive. Unfortunately doctors can’t please everyone, because the patients may come to seek advise. But I believe that they should till be treated like a human and not a walking disease to fix.
I believe that the main issue isn’t the healthcare institution, but even higher; capitalism. It has put a monetary value to time,, and it has intertwined itself into other big institutions such as medicine and healthcare. With corporate heads at the top of hospitals, time becomes money. Now the doctors must diagnose and treat in shorter time, and see more people, but also have more frequent visits to get everything covered and updated.
It can be hard to change, extremely hard, but I don’t think it can be realistically done until we have the right people in the right places. Doctors with an understanding in business to both advocate for the doctors and patients in term of timing and scheduling that ends up being profitable and more organized in the hospital. Then doctors won’t feel as pressured to answer to people who don’t understand how the clinics work, so they can relax and really take the time for their patients.
When reflecting on this prompt, a specific image came to my mind. It’s called “Behind the Scenes.”
Here is the image: https://olhaseredyuk.files.wordpress.com/2015/02/3588588_orig.png
I took a picture of it at the Rollins School of Public Health. It’s part of a larger project called: “Illustrating A Point”: http://www.illustratingapoint.com. The artist behind this particular image, Jeffrey Morgan, includes this comment:
“The issue I have chosen to address with this piece is the lack of transparency in our healthcare system. Many forces are at work behind the scenes that influence healthcare workers and patients alike. Access to care and quality of treatment are complicated by these outside interests that come between doctors and their patients.”
While I will not go in depth into the image and attempt to discern every detail of it, what I find interesting about it are the body positions of the clinician and the patient. The clinician is standing up and she is holding a clipboard, while the patient is seated and his head is tilted slightly downwards and his feet hanging from the bed in the room (implying a childlike quality). The postures alone say a lot to me about what kind of conversation is going on in the room – the clinician is “dominating”, as Amy has said.
Realistically, the healthcare system will not change overnight to accommodate the needs of everyone and it will not change the culture of its pace. At one point during our discussion last week, Dr. Raggi-Moore posed the question of why there are more doctors in plastic surgery rather than pediatrics. It is clear that medicine, in many ways, has become more about doing business than following a calling. While it is important to consider the implications of the interests of medicine, the interests that may drive it should not facilitate interruptions. I say “should not”, because if a clinician is concerned with ethics, he/she will remember that they took the Hippocratic Oath, an oath to the very principles of medical ethics from the 4th century BCE: “to help and do no harm” (Epidemics, 1780). Having looked into some of the ethical principles surrounding healthcare, one big one is having respect for autonomy (Beauchamp and Childress 2008). In health care decisions, respect for the autonomy of the patient would imply that the patient has the capacity to act intentionally, with understanding, to make a free and voluntary act regarding his/her care plan. I think it must be recognized that the patient who entrusts his/her life into the care of the clinician is intuitively and ideally interested in helping him/her self. The patient must be included not as a victim of the care plan, but as a participant, moreover: as a beneficiary of it. Since the question posed for this particular Scholarblog prompt assumes that the clinician who interrupts is interrupting a rational patient – one who has the capacity and can operate in such a way as to make an informed decision – in my opinion it is indeed unethical for the clinician to interrupt the patient, given the autonomy case and the simple case that interruptions do more harm than good. This right of expression should be communicated by the clinician to the patient, but also I think it’s necessary for patients to go in knowing they can and should speak up for themselves and have the ability to talk to the doctor or communicate that they need another one if they are not being heard. While I do not hold the answers to ethical decisions, ultimately I think it is necessary to avoid “casifying”, and to understand that all ethical decision making regarding conditions should begin via engaging a basic ethical attitude through transparent communication towards patients as people first. Of course, there is always the issue of time, etc. – but I’m beginning to think that what if we are making excuses, and what can be done to recalibrate ourselves as people, as clinicians? I am a big believer in the fact that once someone puts their mind to it, they can do it. Jumping cultural hurdles and interests can be tough, but it can be done.