The doctor-patient relationship is just that: a relationship.And inherent to any relationship is vulnerability and trust. That’s why it takes time to develop and grow. It certainly isn’t formed in a one-off ten-minute consultation.
Yet, over the years, we’ve seen a shift that has meant we’ve moved away from doctors actually getting to know their patients and understanding and developing a real relationship with them, to patients never seeing the same doctor more than once.
Increasingly, seeing a doctor has been reduced to sitting in front of someone who barely looks up from their keyboard before issuing you a prescription.
What a dreadful, diminished experience that is.It completely denies all the evidence that shows the extraordinary value of a trusted doctor-patient relationship. Sure, it might be OK for an ear infection, but what about when things are a little more complicated?
A study was published last week that looked at patients with dementia who were regularly seen by the same doctor — and it discovered something rather surprising.
A study found patients with dementia seen by a GP who knew them and had a relationship with them were ten per cent less likely to be hospitalised (file image)
Those who were seen by a GP who knew them and had a relationship with them were ten per cent less likely to be hospitalised.This wasn’t because the doctors were negligent in some way: quite the opposite.
It was because the doctors who really knew their patient could see that something was wrong and treated them before things escalated and they needed a hospital admission. Those GPs were able to act proactively precisely because they knew their patient so well.
But seeing the same doctor more than once has become almost quaint — something from a bygone era, like chimney sweeps and gas street lamps.This is a travesty.
One of the things I treasure about being a psychiatrist is that I do get to know my patients very well. Some of my patients have told me things that not another person on the planet knows about them, not even their partners.It’s an incredible privilege being invited into people’s lives in that way. I’ve been lucky to develop relationships with them over years and have seen the value that this can have on patient care.
One particular patient, whom I’d known for about six years and saw every month or so, came to me one day and I knew something was different. I just got a sense that something wasn’t right, though I couldn’t quite put my finger on it.
I asked her several times if she was OK but she brushed this aside.She was bright and breezy and superficial. She’d been dogged by depression, following years of abuse and, in fact, anyone seeing her who didn’t know her would have said she was making a good recovery.
Yet I felt unsettled. I can’t really tell you why.It was instinctive. I tried speaking softly to her, but she continued in her breezy, happy-go-lucky manner.
Eventually, I snapped. ‘I’m not letting you leave until you tell me what’s wrong,’ I said firmly. ‘There’s something you’re not telling me.’
Dr Max Pemberton (pictured) said doctors cannot develop a relationship, when patients are increasingly being dealt with as though they are on a conveyor belt
I had no idea what it was, but I was starting to get worried.I crossed my arms and looked at her sternly. To be able to be this stern with a patient, you have to know them pretty well.
Plenty of patients wouldn’t have taken kindly to being spoken to like this, but this is where having a proper relationship with a doctor is important.They know you, and you know them. She knew I cared about her deeply and that I wouldn’t be so stern if I wasn’t truly worried.
Suddenly, everything changed. She seemed to crumple into her chair and she burst into tears.
Then she told me the truth. She’d spent the weekend writing her will and getting her affairs in order because she had decided to kill herself.She had planned and prepared everything.
This sometimes happens when people have decided to kill themselves — the decision to end it all is accompanied by a brief sense of relief and euphoria so they can appear to be brighter and happier than they have ever been. This is what had happened to my patient.
Had I not known my patient so well and if I had felt unable to stand my ground with her, I dread to think what would have happened.
For me, this is what being a doctor is really about: it’s about the relationship with the patient as much as the medicine.
But you cannot develop this relationship when patients are increasingly being dealt with as though they are on a conveyor belt, seeing whichever doctor happens to be free.
Medicine isn’t just about signs, symptoms and diagnosis.It’s about people.
We seem to have forgotten this, and in the process, risk losing something incredibly valuable.
- If you need support, call the Samaritans free on 116 123
Why Fiona should invite anti-vaxxers on to TV
Dr Max said it’s vital the misunderstandings and misinformation around the vaccine are discussed openly.Pictured: BBC TV’s Question Time host Fiona Bruce
BBC TV’s Question Time has drawn criticism for encouraging vaccine sceptics to join the audience this Thursday to debate Covid. The host, Fiona Bruce, said: ‘We know there are many different reasons people choose not to get vaccinated.I think it’s an important debate.’
Some say we shouldn’t be giving these people air time, but I don’t agree. It’s vital the misunderstandings and misinformation around the vaccine are discussed openly. We should never be scared of debate and should have faith in science to put forward a compelling argument.While it’s unlikely to change the view of die-hard anti-vaxxers, it will expose some of the falsehoods about the vaccine and help those who are hesitant make an informed choice.
- The fashion industry loves to push boundaries and surprise and confound, but Valentino really upped the stakes at its couture show last week.It wasn’t the clothes that raised eyebrows, though — it was the models. Normal-sized women who actually had curves!
Yet how can this still be the exception to the rule when it comes to models on the catwalk?
What is the fashion industry’s obsession with emaciated women? I just don’t get it. Although a few models naturally possess androgynous, skeletal body shapes, a fair few starve themselves in order to survive in this cut-throat business. What kind of industry encourages such warped perceptions of the body?
I hope Valentino starts a trend that the rest of the fashion world eventually follows.
Dr Max prescribes…
Weighted eye masks
Dr Max revealed he is a big fan of weighted eye masks, designed to apply a gentle pressure around your eyes that induces a feeling of calm and improves sleep quality
Last year we had weighted blankets.Now we have weighted eye masks — and I’m a big fan. They are designed to apply a gentle pressure around your eyes that induces a feeling of calm and improves sleep quality. Just what the doctor ordered.
- Rest Easy Sleep Better Weighted Eye Mask (above), £15, johnlewis.com