The title "Doctor" disrespects patients

A Patient wrote:

How can we feel like equal partners in our healthcare in the face of this kind of language?

http://www.bmj.com/content/351/bmj.h6240

+1! Do you think we have a case!?!? We should sue! Even if they settle we'll get mad paper yo!

She's knowledgeable about clinical ethics and the concern behind this misguided idea is right, namely, that the hospital setting is designed to make patients believe in and obey the doctors, but that an interactive process in which the patient can divulge all the useful information, question the doctor without fear, and help each other understand what should and can be done is best for the patient's health. Now, the placebo effect and the willingness to follow the medical advice would be reduced without some of that special clothing and title and other deference provided the doctor. So, it would be harmful. On the other hand, if the doctor sets the patient at ease enough to really learn about the overall circumstances causing the difficulties in their health, then real solutions might be found and followed. For instance, one of my students is often ill and his doctors haven't spoken with him long enough to ask questions about whether he has travelled to other countries recently. I did that almost right away when I heard of his maladies, and it turned out that he ate something that made him sick on a foreign trip not that long ago, and so I told him to have his doctors check that out. So, that is the basic and valid concern behind this idea. However that can be achieved it should be done.

I should add that in today's medical environment, the doctor's advice is so often wrong (usually demanding test after test after test rather than restraint and patience) that patients need to knowledgeably question and doubt their decisions. I'm thinking now of the series of lymphoma tests for my child that a young doctor sent us on for months. They were all negative but the doctor wanted us to then go on to more tests. The older doctor at the clinic took one look and said that it was nothing other than limited swelling that occurs with illness. Patients should absolutely not listen and follow everything doctors say.

Ever hear of a paragraph??

I can live with the title. It's the condescending attitude, their sheer arrogance, the inability to think outside the box, and the inhumane bills that are a little bit problematic.

tl;dr

....well I guess I read some of what you have written. You're a teacher, yes? Have you ever given a lesson to your students on the difference between an anecdote and data? Also, if I understand your main thesis--should we all stop learning/going to school/mastering a trade? I ask because it seems like you're implying that we all know everything and, thus, should be considered on par with a trained professional despite our lack of training in any given field.

Exactly. When someone is about to cut me open to take something out of my body, the most comforting thing they can do is to ensure me that they are a regular guy who is no better than me.

Another Patient wrote:

I can live with the title. It's the condescending attitude, their sheer arrogance, the inability to think outside the box, and the inhumane bills that are a little bit problematic.

It's MBAs, not physicians who are driving rising healthcare costs. If your doctors all worked for free, your hospital bill would still be astronomical. Thinking outside the box is also really stifled by risk analysts.

With regard to their attitudes, I guess you work with different physicians than I do. I haven't found them to be any worse or better than any other professionals.

"Consider how dumb the average person is, then realize that half of 'em are stupider than that!" - George Carlin

We aren't equal partners in healthcare. We shouldn't be. If I'm seeing someone who has years and years of medical training and I'm an equal partner, then either their education stinks or I'm an exceptional individual.

My mechanic isn't my equal partner in the maintenance of my car. If I don't trust my mechanic, I can go find a new one.

I'm not arguing that we shouldn't be critical of our doctors or hold them to high standards (especially given what we pay them). Nor am I arguing that patients shouldn't have a voice in their care. But I do believe that the author of this article is over-estimating the costs and under-estimating the benefits of a title.

I would be curious to know whether outcomes differ significantly between patients who undergo treatments contrary to their doctors' recommendations and patients who express doubt about their doctors' recommendations yet abide by them regardless.

Hi, as a Doctor I figured I would weigh in on the discussion. One of the most unfortunate biproducts of the concept of "partners in health" is that many people subsequently feel like healthcare is a restaurant and they have the right to order whatever study/test they want.

I simply cannot emphasize enough, how people who have not had years of training cannot really make an informed decision. I could not make a completely informed decision after completing four years of medical school. You really only acquire the necessary knowledge to make good decisions after completing residency. Even after that is done you still often do not understand topics that are outside your area of expertise. For example, as a radiologist I spend a lot of time with clinicians making sure the right study is ordered for the patient because the have ordered the wrong study. So imagine how ridiculous it is for a patient who does not have any background in healthcare "demanding" an MRI because they want it.

I am not being supercilious. I have family who are not in the healthcare profession, including my father who is a biomedical engineer with an IQ of 150. Even he does not understand some of the most basic concepts of medicine.

Many doctors, including my wife who is an internist, have become quite disgruntled with the direction healthcare is going. Ungrateful DEMANDING patients are not the same as grateful patients/family who want to understand what is going on. Unfortunately the former is more common.

The article is hogwash. I went through 10 years of training beyond undergrad not so I could be called doctor, but so I could receive the knowledge necessary to make the proper diagnoses/decisions for a patient so they can get better. Frankly I do not care what people call me, but let me do my job...

a doctor wrote:

I am not being supercilious. I have family who are not in the healthcare profession, including my father who is a biomedical engineer with an IQ of 150. Even he does not understand some of the most basic concepts of medicine.

I beg to differ. Anyone who uses the word supercilious on LRC, clearly is being supercilious.

a doctor wrote:

Ungrateful DEMANDING patients are not the same as grateful patients/family who want to understand what is going on. Unfortunately the former is more common.

I think it's time that you got out of the medical game if this is what you truly believe. With this attitude, you are more likely to cause a patient a lot of harm rather than benefit. In fact, you have the same attitude as Harold Shipman which is really disturbing.

Truth Doctor wrote:

a doctor wrote:

Ungrateful DEMANDING patients are not the same as grateful patients/family who want to understand what is going on. Unfortunately the former is more common.

I think it's time that you got out of the medical game if this is what you truly believe. With this attitude, you are more likely to cause a patient a lot of harm rather than benefit. In fact, you have the same attitude as Harold Shipman which is really disturbing.

Seriously. This seems to be a common trend when doctors post on here. They prove exactly what they are trying to say is false.

I'm sympathetic to this. I'm glad to grant someone the title of doctor if he actually deserves it, but just because you graduate from medical school and get a government license doesn't mean you're worth a damn. The fact of today's healthcare industry is that MDs/DOs have a government-granted monopoly over the field of medicine, as a result of which they don't actually have to be good at what they do in order to survive professionally. The field is so regulated and stifled by government controls that many of the most gifted and innovative individuals have turned elsewhere to fields that give them more freedom to use their minds, leaving medicine open to pompous mediocrities who see it as a path to prestige and care nothing about the actual work. The ones who care most about the title are the ones who deserve it the least.

Did you ever hear of a complete sentence? A paragraph is for one complete idea, which I expressed. However, paragraph rules differ on message boards and essays. Did I strain your poor excuse for an attention span, text boy?

Thank you for informing me that an anecdote is different from data. Specifically, it is the basis for the abstract unit called a datum, but not stripped of the relevant and useful information that a datum would have. If you have reason to think that doctors spend long enough with patients to get to know them or that the difference in status between doctor and especially low income patients does not adversely affect their health care, then please let us see it.

An NY Times article cites an average of eight minutes spent with patients.

This article discusses the issue in depth and indicates that not only has Dr.-patient contact time decreased, but that

"In a British study by Roland et al., physicians who increased their average office visit length from 6.7 minutes to 7.4 minutes (face-to-face time) asked more questions related to health history and psychosocial concerns.22 In addition, physicians with longer visits made more statements about health education and prevention. Using the same study group, Morrell et al. found a greater likelihood of detecting psychosocial concerns in the group with longer visits.7 In another British study, Wilson et al. found that physicians who increased their average visit length from 7.1 to 8.2 minutes increased their rates of hypertension screening and health education activities.23"

"Kaplan et al. studied general internists and family physicians as part of the Medical Outcomes Study (data from 1986).5 They had previously found that patients of physicians with a “participatory decision-making style” had better health outcomes and were more satisfied. They found that physicians with a more participatory decision-making style were 30% less likely to have patients leave their care. In addition, physicians with a practice volume under 70 visits per week tended to have a favorable decision-making style. Kaplan et al. did not, however, report actual visit lengths.5"

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496869/

Thank you for this post. Jenny McCarthy is an example of someone who decides her "experience" outweighs years of education and specialized training.

I would care about your opinion if I hadn't seen 3 doctors in a row, in short succession, who all had different advise about how to treat me. --Some background, one doctor was ancient, angry, burned out, an incapable of listening. The next doctor, didn't ask enough questions before advising my doing exactly what I had done for 15 years that reached the law of dimishing returns and was no longer working. The 3rd doctor was 29, fresh, young, listened and found a successful new treatment.

And doctors attitudes change over time. A second doctor treating me, issued me an ultimatum through her PA to go to a certain clinic, or else she would not longer prescribe for me. --She'd already been notified that I needed a bridge prescription BECAUSE I HAD MOVED 300 MILES AWAY, and was still finding a new Primary Care Physician. She had this ultimatum issued by her other PA, for whom English was also her second language. Pissed me off on the spot. I don't believe "ultimatum" is an appropriate word in a medical relationship. "Requirement," totally fine.

If I had still been going to that clinic I would have told her to her face she was fired. BTW, at the start of our "partnership," she was fine, great, listened. She just devolved into automatic mode and rushed through reading the notes from the other doctor/s. Totally stupid issuing a patient an ultimatum to go to a clinic nearby when she'd been informed two weeks before, and even before that in person, that I was moving 300 miles a way. And then to be culturally so underedcuated (Hindu) as to not know how innappropriate the word "Ulitimatum" was in so many context.

On the other hand, I had many great doctors at the same entity. But that was a head slapper.

Every damn post is tl;dr what's wrong with you people?