The (Modern) Doctor's Dilemma

A young redhead with an acorn-shaped face and almond eyes stands next to his family, clearly struggling to keep up under the pressure of his walking boot. A woman in a light blue uniform ushers him in through the doors, brown and dull like the others. He locks eyes with a tall middle-aged man in a chic white trench coat, caressing a clipboard with his bristly arms. The man smiles briefly before averting his gaze to his clipboard. Smile dissipating from his face, he transitions to a string of questions: “So, what brings you in today?...Where does it hurt?...How bad is the pain?...Has this been a recurring issue?” After a series of nods and scribbles, he brings the boy’s parents into the room and reads off the page. Neglecting the quizzical look on the parents’ faces, the doctor proceeds with his medical jargon, gesturing with his hands so as to not completely ignore their presence in the interaction. As he looks up from his clipboard, he scribbles a prescription for pain medication before sending them on their way, five minutes into the interaction.

Too many hospitals and private practices have long-since forsaken the humanistic treatment of patients in favor of a strictly anatomical view, treating patients more like problems to be fixed rather than people with feelings and complexities. But recently, select groups of physicians have been seeking alternatives, integrating the patients’ individuality and experiences into the traditional patient-physician dynamic. According to Shift Integrative Medicine’s Clinical Director Patrick Walsh, MS, integrative medicine “takes the best aspects from traditional and alternative medicine and combines them so you don’t feel like you have to make a choice between the two.” Integrative medicine takes consideration of all factors that influence health, treating the whole person: his body, mind, as well as spirit. An attractive aspect of integrative medicine is its focus on non-invasive treatment methods, “trying to help the body heal itself” rather than over-rely on invasive procedures that can disrupt the body’s natural biorhythms. As the owner and founder of Shift Integrative Medicine, Director Walsh highlights a central belief of his work with Shift as well as integrative medicine as a whole: “Most people, when they get injured, want to get back to where they were before, which is right before you hurt yourself. So I say a better model is a transformational approach, where patients take pain and injury as a transformative opportunity.” Though recovery is not always possible, people can evolve to their new circumstances, working with physicians to shift their self-awareness and “claim something new.”

A fundamental tenet of patient-centered care concerns the relationship between health providers and their patients. According to New York City Pain Specialists’ Medical Director Karan Johar, M.D. and F.A.A.P.M.R., “the doctor-patient relationship is a sacred partnership,” in which physicians “are both scientists and family members.” Dr. Johar observes that doctors must “connect with patients, understand their personalities, and be mindful of presenting them with all treatment options, reviewing all risks and benefits to allow the patient to make the most informed decision.” In the tricky situations when patients fail to receive proper diagnoses and relief from their ailments, patients tend to blame the doctor for their inability to diagnose the problem while physicians point to the patient not following up despite instructions. However, underlying this recurrent issue is often a fundamental lack of relationship between the patient and doctor. Patients want to feel a personal relationship with their caretaker, trusting that the physician will look out for their best interests: minimizing costs, reducing symptoms, and empathizing with the patient. Doctors want cooperative patients who listen to their suggestions and actually heed their advice. Indeed, patients who make no effort to improve their own health make it very difficult for both sides involved. An important responsibility of the physician is to help patients be accountable and proactive about their own health. Dr. Johar notes that “a patient who only takes blood pressure pills may mask their issue, but one who decided to lose weight by diet and exercise may one day be free of pills.” Simply relieving the pain is not enough. Doctors must help the patient take ownership of their health, helping them make sound lifestyle choices to prevent future ailments. Just like a good family member, a physician must be willing to say unpleasant things for the good of the patient, “optimizing their functional independence” by encouraging them to quit that addiction or give up that bad habit. Patients must be patient, trusting in the doctor’s judgment and working diligently to improve their health, no matter how long the road to recovery may seem. It is always worth the wait.

What I have found most fascinating in my interactions with Dr. Johar and Director Walsh are the holistic approaches they use to make patients feel safe and supported. Through various initial dialogues, they help the patients decide what is best for them, taking the time to listen to the stories behind the ailments. They make sure to work on various aspects of the person’s physical, mental, and emotional well-being, not just fixing the pain, but pinpointing the underlying behaviors that cause the pain. Through their passion and drive to improve healthcare, I have acquired a new sense of what it means to be a healer, kindling a new spark in my quest to become a clinical physician. Through people like Dr. Johar, Director Walsh, and others who believe in their holistic approach, we can hopefully look forward to a change in the current model for patient care.

Many aspiring physicians say that they want to enter the medical field to help people. But in the daily grind of clinical life, many physicians lose track of why they wanted to become doctors in the first place, so fixated on administration and paperwork that “patient-centered care” soon becomes lost in a pile of facts and files. Physicians could use a perspective change, taking patients on a journey rather than necessitating an end. However, the onus is never just on the physician. Relationships go both ways. Patients must trust their doctor for change to happen, being receptive to the doctor’s suggestions, open to unpleasant truths, and honest about all symptoms. A genuine “thank you” with a smile wouldn't hurt either. Some simple modifications on both sides would improve the healthcare system immensely. Patients would get better treatment and doctors would feel more engaged and fulfilled in their work. As the professionals, doctors must not be complacent in accepting the traditional patient-physician dynamic. Physicians must strive to do more than they need, working to develop relationships with patients and truly make a difference in their lives. The craft of the human body. The honor of giving life to the befallen. The sheer joy of helping someone through their times of desperation. These things should never grow old.

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