Recently, The New York Times began a column, “Doctor and Patient,” with “Healing the Doctor-Patient Divide.[1]” The author (a surgeon) sets the scene with a description of a neighborhood barbeque, during which conversation turns predominantly to health and to one theme in particular: the feelings of patients being at odds with their doctors. The author suggested the problem is the loss of an “ability to converse thoughtfully with one another.” As a beginning remedy, a Web blog “Doctors and Patients Start Talking” accompanies the column.[2]
In 6 days, 439 comments were posted on the blog. Many highlight problems within the healthcare system at every level, including variations on the theme that doctors don't listen. The author returns 6 comments lacking even the spirit of inquiry.[2]
There is no conversation, let alone “thoughtful conversation,” between the author and the audience, between doctors and patients. It's not even possible. A conversation, by definition,[3] is an informal interchange of thoughts by spoken words. The Web blog is aurally and visually silent. It is a cyberwell of stories, but as a medium it probably has little real healing potential for a living, breathing doctor-patient relationship. Indeed, it underscores the divide the author so wishes to heal by removing the intimacy of physical presence between 1 doctor and 1 patient.
In a thoughtful conversation, it's expected someone will listen to what you are saying, how you have uttered it – the tone of voice, the words used, words perhaps avoided, your body language. But the expectation is reciprocal; one must seriously hear the other in response. A conversation with healing potential may be awkward, incomplete, surprising, brief. It may even occur during a “6-minute” consultation between a doctor and a patient.[4] For the doctor, however, it requires the utmost presence and attention and a certain kind of vulnerability.
That's my opinion. I'm Dr. Ursula Snyder, former editor, Medscape Women's Health.
Footnotes
Reader Comments on: The Doctor-Patient Relationship I: The Web Underscores the Divide See reader comments on this article and provide your own.
Readers are encouraged to respond to the author at usnyder@eastlink.ca or to Peter Yellowlees, MD, Deputy Editor of The Medscape Journal of Medicine, for the editor's eyes only or for possible publication as an actual Letter in the Medscape Journal via email: peter.yellowlees@ucdmc.ucdavis.edu
References
- 1.Chen PW. Healing the doctor-patient divide. New York Times. September 11, 2008. Available at: http://www.nytimes.com/2008/09/11/health/chen9-11.html Accessed December 15, 2008.
- 2.Doctors and patients start talking. New York Times. September 11, 2008. Available at: http://well.blogs.nytimes.com/2008/09/11/doctors-and-patients-start-talking/ Accessed December 15, 2008.
- 3.Webster's New Universal Unabridged Dictionary. New York: Barnes & Noble; 1996. p. 444. Conversation. [Google Scholar]
- 4.Balint E, Norell JS, editors. Six Minutes for the Patient. London, United Kingdom: Tavistock Publications; 1973. [Google Scholar]
