3 Types of Doctor’s Relationship You Might Experience In Your Lifetime
According to Atul Gawande’s book Being Mortal, there are three types of relationship a doctor could have with their patient. This is especially crucial when it comes to seeking treatment options because the type of relationship you experienced with your doctor may influence your decisions, as well as the kind of trust you have with the healthcare system.
1. I have it figure out (Paternalistic)
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A paternalistic relationship between a doctor and patient is more common than we think. Essentially, the power of the relationship is unequal as medical professional are bestowed with clinical knowledge to provide the best course of action, often measured towards sustaining life and survivorship. The doctor tells the patient what s/he should do and tend only to discuss options that are optimal.
I fondly remembered one client (let’s call him Jimmy) in my Advance Care Planning session. Jimmy shared about his negative first-review-visit-to-the oncologist’s experience. After being diagnosed with cancer, the doctor zoomed straight to talk about the statistical probability of survivorship rate based on the different type of treatment available before settling for a recommendation in a couple of minutes. My client was taken aback because the information was coldly served, as if he did not matter in the conversation. What seriously inked in Jimmy’s mind was that when he tried asking if he could do away with chemotherapy and sought for other alternatives, the doctor got offended and retorted that if there are better options, he would have recommended. And if Jimmy doesn’t wish to take his recommendation, why is he even here?
Ouch. The experience was so poignant that I could see his intense anger flaring simply by retelling his story. Jimmy felt that there was a lack of respect for individual dignity and autonomy. Hence, he could not trust him, despite that fact that the doctor was supposed to be some top oncologist. No prize for guessing that Jimmy walked and that is the last time he saw him.
Key word? I have figure it out.
2. You got to figure out (Informative)
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An informative relationship is one which the doctor lay down all facts and figures towards the best options and let the patient choose. This is certainly more helpful than a paternalistic relationship. However, this only works best for simple issues with clear choices and straightforward trade-offs. If the issue is more complex and emotional, then this method doesn’t really work as well.
Though intuitively we may think that most doctors’ relationship are informative, in my experience, there is two general positions within this relationship.
For example, I used to visit a client (let’s call him Gerald), who was found to have a tumour in his stomach. On the surface, the doctor seem to have an informative relationship with him. He lay down all the facts – either he goes for a high risk operation to remove this tumour or he lives with it. If the operation fails, Gerald is not likely to survive. If he succeeds, Gerald gets about 5 years of lifespan. If Gerald decides to live with the tumour in him, conservative treatment will give him about 2 years of lifespan.
Certainly the relationship sounded a lot more informative than paternalistic. However, what was key but subtle was that the doctor added “if I were you, I will take the operation”. Sometimes in midst of the conversation, doctor can unconsciously shift one’s preference for treatment over another due to some underlying values. In that respect, the doctor actually adopt a weak informative relationship because there seemed to be a streak of paternalism within. A strong informative position is much more neutral. The relationship focuses on laying facts and figures because people can decide on their own. Even the choice of words are carefully spoken to minimise certain unconscious nudging.
Key word? You got to figure out.
3. We have to figure out (Interpretive)
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Interpretive relationship is somewhat a middle way among the above two relationships. In fact, it sounds almost like what a good interior designer would do. A good interior designer will always probe their client details of their ideal home and design a house that best fits those characteristic. A less impressive designer will either impose their design ideas onto their client squarely or ask them to pick design concept among his past works.
An interpretive relationship is where a doctor helps determine what the patient wants by asking them their key concerns and importance things in life. Ideally, medical decision should be based on such values because things that are personally important are personally meaningful. It is essentially a mix of both relationship above.
For example, I used to have a client (let’s call him Zed) who wants to continue a losing fight against pancreatic cancer because he felt that his children were too young to live without a father. As such, Zed wanted to extend his life as much as possible because that was personally meaningful for him. Though it may seem futile in the eyes of another pancreatic cancer patient or doctor, but it is important to realise that people are ultimately driven by purpose. He wanted to fight a futile battle because every minute is precious to him and his family. The doctor knew what was important to Zed and devise his treatment plan based on Zed’s values and not solely on statistic or the doctor’s underlying value. The doctor used his expertise and knowledge to craft out the best plan so that he could match the needs of his patient.
Sometimes, an interpretive relationship might clash with the doctor’s value. Like in Jimmy’s case, his original doctor could not accept what was important for him. Fortunately, Jimmy manage to find another doctor who is willing to treat him in his own terms. No chemotherapy because Jimmy has a worldview that chemotherapy is toxic. He strongly believe that he is likely to die from the treatment and would have a much lower quality of life. But he was happy that his new doctor is willing to work with what was important for him and naturally, he entrusted his care to him.
A good doctor may put everything on the table for you to decide, but a great doctor helps you to piece those options on the table into a purposeful plan fundamentally based on what is personally important for you.
Key word? We have to figure out
Our relationship with our doctors is an important one. Preferably, we want someone we can trust because in some cases, these may be life and death matters. And even if we may succumb to our illness, a doctor that respect your dignity and autonomy would certainly improve your overall care experience and your quality of life.
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