Monday, April 2, 2012

Doctor-Patient Closeness and Clinical Uncertainty

As a person wanting to become a physician, I found Groopman’s How Doctors Think to be an extremely fascinating read. One of the most interesting things Groopman mentions is the fact that the closeness between a doctor and a patient may actually impair, rather than assist a doctor’s ability to comprehensively and correctly assess, diagnose, and treat a patient. If a doctor and a patient are or become friends, are or become quite close, or develop a particularly emotionally laden relationship, a doctor’s clinical judgment may be clouded. He or she may not present a potential diagnosis because of the label or stigma it carries, its severe implications or its lack of responsiveness to treatment, he or she may not present a possible treatment because of its side effects, or he or she may not even consider a particular diagnosis or treatment because of its severity and not wanting to potentially be the “bearer of bad news” to someone whom he or she care about, among other things.  When a doctor and a patient are close, the emotion in that particular relationship may hinder a doctor’s comprehensiveness, ability to perform at his or her clinical best, or change the way that doctor interacts with the patient compared to a patient with whom he or she is not close for the worse. Thus, it may be in a patient’s best interest to seek care from a physician whom he or she is not particularly close with in order to receive the clinically best, least biased, and emotionally hindered care. In such a relationship, with all of the potential diagnoses and treatments (hopefully) properly considered and laid out on the table, a patient may be able to make a more independent, fair, and informed decision.

On a more personal level, after reading Groopman’s novel, I realized just how much uncertainty the field of medicine contains. When assessing and diagnosing a patient, I understand that the process of making differential diagnoses and then coming to the most likely diagnosis contains a certain level of guesswork and uncertainty. I also understand and know that there is a certain amount of risk involved in most of medicine. After reading, however, I was compelled by the fact that there is so much variability between how radiologists read x-rays, scans, MRIs, etc. To say that the same set of radiologists are able to come to a conclusive reading of and the same diagnosis based on the same x-ray is far from the truth. I am also surprised by just how much variability there is between the diagnoses different doctors come to regarding the same clinical case or presentation. This is illustrated by Groopman’s quest to treat his own diseased hand and the number of varied and unfounded diagnoses he was given by a number of different doctors. As a person with a highly perfectionist personality, with whom a high level of uncertainty does not sit particularly well, reading Groopman’s novel opened my eyes to and helped me understand just how much uncertainty exists in the medical field and how to a certain extent, this uncertainty is inevitable and doctors must learn to come to terms with it in their clinical practice. 

1 comment:

  1. I agree with you, I think it is scary how the relationship between the doctor and the patient can effect the treatment as well as the diagnose. There is no right relationship with a doctor because he or she will judge you either way if they really like you and if they really don't like you, so either way you will cloud their thinking. This book also made me think that doctors who have made many errors are better doctors than those who haven't because they have learned more by making those mistakes.I also agree that this book shows how much uncertainty there is in the medical field and how easy it is to not notice certain symptoms, it made me a little intimidated about going to medical school, but relieved at the same time because I want to study psychiatry and it seems that it is much easier to recognize psychological problems compared to what regular physicians have to recognize.