Doctor-Patient Conflict series: 1. Apathy #AtoZChallenge

So, here we are on day one and, at A

Patient’s perspective: What a Patient sees/feels: Apathy

Physicians hear this word frequently from lay people whenever the subject of interactions with the medical community comes up in conversation. What does the term suggest; what are people trying to convey? Pathos is a Greek word for suffering and feeling. A-pathy implies a lack of feeling – a lack of interest in and indifference to suffering.

Anyone who goes to a hospital has some anxiety either for themselves or for their loved ones; often both. The body suddenly seems like a complex unwieldy ‘other’ that is refusing to respond to what one is routinely used to doing. That is a frightening experience and naturally, a patient’s expectation is for understanding, empathy and a mirroring concern. ‘If you don’t listen, understand and empathize with how I am feeling, how can I trust you to know enough about what’s going on inside me to cure me?’

How does a doctor respond to the charge of Apathy

It would seem obvious, apathy is the last thing that doctors – whose job it is to be concerned about another’s illness – want to hear or be associated with. Yet, the frequent response you will see/hear from a physician when you mention apathy is, not alarm but, frustration and annoyance. Very rarely will you hear regret. And unintentionally, this response does little to allay the charge! Why then do doctors react this way?

The doctor’s perspective:

Because a doctor doesn’t believe it is his job anymore to convey emotion and empathy. He/she instead sees it as his job to ‘fix the problem’ with whatever tools he has available to him at that point in time. If you’re now feeling nostalgic about older times and family doctors consider how much medicine has changed in the past few decades.

Medicine is no longer a trade of one stethoscope, two hands and a mind. With those sort of tools, talking to the patient is a necessary first step to treat his ailment. From then, and over the past two decades, to our present time, medicine has been flooded with drastic technological innovation that has, quite naturally, changed the rules of practice.

A physician has had to make the mental shift to accommodate technology to his own style of practice and adapt to the bewilderment of a fast changing workplace. At work, there is therefore, not just a time constraint; there is also a switch in self perception.

When doctors once saw themselves as part of a community and actively engaged with it; they now consider themselves as tradesmen with a specific set of skills that they need to fine hone with experience. That, that experience comes at the hands of a living, flesh and blood human has become somewhat incidental. In a certain sense, what clay is to the potter or bronze to the sculptor, is what the body has become to doctors. Accordingly, the relationship with the patient community has also altered and increasingly, doctors have detached themselves from the community, retreated into large hospitals, set up hierarchial levels of separation between themselves and the patient (from receptionists through trainees and nurses to junior consultants) and rely on technology to tell them what is wrong with a patient rather than on the time consuming task of talking with a patient and taxing the brain to figure it all out.

Where to, from here?

The problem is one of perception and expectation. Patients need to wake up to the fact that medicine’s workplace has changed and that what seems like Apathy might be just that; but, in a more real sense, apathy is no longer what a doctor should be assessed for. Instead, the expectation should shift to competence and cure.

If this looks like I am letting doctors get away with too much; it is quite the opposite. Apathy is subjective, has no defined metric and the doctor/system can easily get away by shifting the blame on to the patient’s neediness and difficult attitude. The last especially happens often because the very expectation of an emotional response cedes power (from patient to doctor) and is an unconscious admission of vulnerability.

By shifting your own expectations as a patient and insisting instead on competence; you are in effect, shifting the onus of responsibility back onto the doctor, now with a definable metric. Importantly you are assuming charge of your body, asserting your own rights and bringing some much needed balance back to the relationship.

A

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