The doctor-patient relationship is just that: a relationship. And vulnerability and trust are inherent in any relationship. That is why it takes time to develop and grow. It is certainly not formed during a single consultation of ten minutes.
Yet over the years we have seen a shift that means we have moved away from doctors who actually get to know their patients, understand them and develop a real relationship with them, to patients who never see the same doctor more than once.
Increasingly, seeing a doctor comes down to sitting in front of someone who barely looks up from their keyboard before giving you a prescription.
What a dreadful and diminished experience this is. It completely denies all the evidence that shows the extraordinary value of a trusted doctor-patient relationship. Sure, that might be okay for an ear infection, but what about when things get a little more complicated?
A study was published last week that looked at dementia patients who were regularly seen by the same doctor – and it found something quite surprising.
A study found that dementia patients seen by a GP who knew them and had a relationship with them were ten per cent less likely to be hospitalized (file image)
Those who were seen by a GP who knew them and had a relationship with them were ten percent less likely to be hospitalized. It was not because the doctors were negligent in one way or another: quite the contrary.
This was because doctors who really knew their patient could see something was wrong and treated them before things got out of hand and they needed hospitalization. These 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 streetlights. It’s a parody.
One of the things I cherish about being a psychiatrist is that I get to know my patients well. Some of my patients have told me things that no other person on the planet knows about them, not even their partners. It’s an incredible privilege to be invited into people’s lives in this way. I have been fortunate to develop relationships with them over the years and have seen the value this can have on patient care.
One patient in particular, who I had known for about six years and saw every month or so, came to see me one day and I knew something was different. I just felt like something was wrong, even though I couldn’t quite put my finger on it.
I asked her several times if she was okay but she brushed it off. It was bright, airy and superficial. She had been dogged by depression, after years of abuse, and in fact anyone who saw her without knowing her would have said that she was recovering well.
Yet I felt destabilized. I can’t really tell you why. It was instinctive. I tried to speak softly to her, but she continued in her flippant, carefree manner.
Finally, I cracked. “I won’t let you go until you tell me what’s wrong,” I said firmly. “There is something you are not telling me.
Dr Max Pemberton (pictured) said doctors cannot develop a relationship as patients are increasingly treated as if they are on a treadmill
I had no idea what it was, but I was starting to worry. I crossed my arms and looked at her sternly. To be so severe with a patient, you have to know him well.
Many patients would not have liked to be spoken to like that, but this is where it is important to have a good relationship with a doctor. They know you and you know them. She knew I cared deeply for her and wouldn’t be so harsh if I wasn’t really worried.
Suddenly everything changed. She seemed to collapse in her chair and burst into tears.
Have you seen the moving documentary about Jay Blades, the 51-year-old presenter of The Repair Shop, learning to read? In the UK, one in eight adults struggle to read, often disappointed by a unique education system. It’s shocking that we still let people down like this.
Then she told me the truth. She had 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 comes with a brief sense of relief and euphoria so they can appear brighter and happier than they appear. have never been. That’s what happened to my patient.
If I hadn’t known my patient so well and felt unable to hold on to her, I’m afraid to think what would have happened.
For me, that’s what being a doctor is: it’s as much about the relationship with the patient as it is about medicine.
But you can’t develop that relationship when patients are increasingly being treated as if they’re on a treadmill, seeing the doctor who happens to be free.
Medicine is not just about signs, symptoms and diagnosis. It’s about people.
We seem to have forgotten this and in doing so we risk losing something incredibly valuable.
- If you need help, call the Samaritans free of charge on 116 123
Why Fiona should invite anti-vaxxers on TV
Dr Max said it was vital that misunderstandings and misinformation around the vaccine were discussed openly. Pictured: BBC TV Question Time host Fiona Bruce
BBC TV’s Question Time has drawn criticism for encouraging vaccine skeptics to join the public this Thursday to debate Covid. Host Fiona Bruce said: “We know there are many reasons why people choose not to get vaccinated. I think this is an important debate.
Some people say we shouldn’t give these people airtime, but I disagree. It is essential that misunderstandings and misinformation around the vaccine are discussed openly. We should never be afraid of debate and should trust science to present a convincing argument. While this is unlikely to change the views of die-hard anti-vaccines, it will expose some of the fallacies about the vaccine and help those who are hesitant to make an informed choice.
- The fashion industry likes to push boundaries, surprise and disconcert, but Valentino really upped the ante at his couture show last week. It wasn’t the clothes that raised eyebrows, it was the models. Women of normal size who 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 understand. Although a few models naturally possess androgynous and skeletal body shapes, a few starve to survive in this harsh industry. What kind of industry encourages such distorted perceptions of the body? I hope Valentino sets a trend that the rest of the fashion world will eventually follow.
Dr. Max prescribes…
Weighted eye masks
Dr Max revealed he’s a big fan of weighted eye masks, which are designed to apply 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 huge fan. They are designed to apply gentle pressure around your eyes which 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