Do Doctors Respect Their Patients? and Vice Versa?

Do Doctors Respect Their Patients? and Vice Versa?

At the National Pain Report, some of our reader reaction has to do with the relationship between doctor and patient. While we are a news organization and not sociologists, it is obvious that the strain on the relationship has intensified for at least some since the DEA rescheduled hydrocodone which has resulted in some access to pain medication issues for at least some patients.

When the National Pain Strategy is adopted, presumably this fall, one of the first issues it plans to address is education - not only of the patient but of the physician.  The National Pain Report has been conducting a survey on the state of medical care - with an emphasis on pain treatment - and it’s fair to say that the results are interesting and, we think, educational. (You should start seeing some results in the next month).

We are writing at this point because of an interesting, and yes mildly disturbing essay. that was published by the Annals of Internal Medicine. It was published anonymously this week by a medical professor and practicing physician. Here’s how the US News and World Report covered it.

For Terri Lewis, Ph.D, who is conducting the survey for the National Pain Report, has been thinking about the doctor-patient relationship. In fact, she talked about a “reboot” coming in the relationship between physicians and patients at an International Pain meeting in June. Here’s how we covered that!

The Annals of Internal Medicine essay prompted some additional thinking from Terri Lewis, which she shared with us:

“The Annals editors chose to publish the essay for the same reason the author appears to have submitted it: To make all who read it think twice before “acting in a manner that demeans patients and makes trainees and colleagues squirm.”

It is my observation that providers and patients have two wholly separate and disparate objectives, particularly in the current health care environment. First the patient believes that she or he goes to the doctor to achieve the disposition of illness that threatens their personhood, represented by symptoms.  The health care provider on the other hand is trained to dispense to symptoms with the goal of remediation and is trained to ‘dispassionately unsee the person.’  

The goals of both parties are achievable when provider and patient work together to restore the personhood lost by the onset of symptoms through the use of respectful communications, collaboration, and mutually agreed upon outcomes.

The current medical system is the thief of time. Like speed dating, both parties may be left to shrug their shoulders at failed outcomes, chalking it up to each others’ personal attributes or characteristics or failure of the other party to understand the rules of engagement.  Our education and business models compete against each other and offer no analysis of causation for failure of both parties to achieve their objectives.

Increasingly physicians operate within a hierarchical business model that reserves power and permission at the top while dispensing the cure from the middle of the hierarch to bottom. On the other hand, the patient wants an environment with a level playing field where communication flows across the parties to treatment - where personhood remains as great or greater than the additive impact of his or her symptoms.  

Both parties become contemptuous of the others’ failure to help them achieve their personal objectives. Dangerously, this contempt is cultivated and becomes hardened through exchanges with two separate sets of expectations for outcomes that leave both parties dissatisfied and contemptuous.  Misogyny blooms where it is planted, representing a system that fails to value engagement and alignment of expectations.”

And for the doctor patient relationship when it comes specifically to chronic pain, she had one additional thought.

“Pain attacks one’s personhood.  And faced with a physician who is operating from a position of ‘dispassionate unseeing,’ the working alliance can seem like the Grand Canyon, and the drop to the river is the option for failure.”

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Authored by: Ed Coghlan

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Ms. Lewis did an excellent job of articulating the disconnect between doctors and people in pain. This disconnect also applies to the National Pain strategy as it promotes outcome measures such as PROMIS which certainly only measures symptoms and not how pain has impacted the life of the person in pain. In addition, the NPS failed to make mention of the treatment burden people in pain have in terms of out of pocket expenses, undergoing urine drug tests, the cognitive and physical workload of care and accessing needed treatments.
The education the NPS proposes begs the question- for if the 80 who created the NPS don’t understand that treatment burden can effect the lives of people in pain and that their outcome measures aren’t sensistive to the lived experience of people in pain- how can the public believe that the NPS plan for education will bridge the gap between providers and people in pain?