Reading Summary

This week, we engaged with two readings and a video. The first reading, “The History of the Doctor-Patient Relationship” by Edward Shorter, delineates three periods: traditional, modern, and postmodern. The traditional era featured under-trained physicians practicing ineffective medicine and experiencing low status and financial struggles. The modern era saw advances in pathophysiology, including clinical examination, pathological anatomy, and microbiology. Despite few therapeutic improvements, the public image of doctors rose high due to doctors treating patients more as people and the view of doctors as scientists. The postmodern era witnessed substantial drug and pharmacology developments. Doctors were vigorously trained as scientists, making them treat patients less empathetically. Consequently, public image fell, exacerbated by media portrayal.

The second reading, “How Doctors Think” by Jerome Groopman, highlights diagnostic errors doctors can make, illustrated through personal examples. Groopman discussed three types of error: representativeness error, attribution error, and affective error.  Representativeness error stems from a thought process guided by prototypes, often blinding one to opposing possibilities. Attribution error involves attributing symptoms to the patient’s fault rather than underlying conditions. Affective error arises when placing excessive value on desired outcomes clouds judgment. Additionally, the video, “Surgical Resident Breaks Down 49 Medical Scenes From Film & TV | WIRED,” revealed how popular media can inaccurately (and accurately) depict medical procedures.

 

I originally prepared four questions: 

1. How do you interpret the doctor-as-a-demigod view? A good thing? Bad thing? In between?
2. This article was written in 1993. How do YOU BELIEVE general perception of doctors has changed (or not changed) today?
3. It seems easy to say that if a patient displays x, y, and z symptoms, then doctors should run x, y, z, and any further testing required to rule out all other possibilities (e.g. McKinley cardiac issues). Why, then, do doctors still make such emotional errors?
4. What is the balance between doctors showing compassion and care for their patients and doctors being scientific (both internally and externally)? (This was answered in another question.)

Questions were added to adjust to the flow of the discussion. 

 

1. How do you interpret the doctor-as-a-demigod view? A good thing? Bad thing? In between?

The consensus was that physicians should not be viewed as demigods, as it could lead to abuse of power and corrupt physicians. It could also put unrealistic expectations and thus unnecessary pressure on physicians. Whether or not physicians could be viewed as a benevolent or evil force, a core theme is a power imbalance over patients.

 

2. This article was written in 1993. How do YOU BELIEVE general perception of doctors has changed (or not changed) today?

Students believed that the perception of doctors has worsened over time. Factors like the rise of Urgent Care, Telehealth, and Zoom meetings have led to less personal interactions between doctors and patients. Although it would be ideal to take the time to assess every patient, classmates feel that it is hard to find a balance; the current system maximizes patient number and efficiency. Therefore, patients feel as though their doctors do not listen to them, causing patients to lose trust.

 

3. It seems easy to say that if a patient displays x, y, and z symptoms, then doctors should run x, y, z, and any further testing required to rule out all other possibilities (e.g. McKinley cardiac issues). Doctors are also aware of these errors. Why, then, do doctors still make such emotional errors?

Classmates discussed the initial judgments doctors make and the human tendency to stereotype.  Some believed that judgment was inevitable, but doctors may still maintain a professional and respectful appearance. Next, we debated whether liking a patient was necessary. While most argued no, some argued that even without open hostility, patients can sense how their doctors feel about them, which could result in patients feeling uncomfortable enough to leave out vital information. 

One classmate claimed that even if a criminal was their patient, they still need to treat them with the same respect they would treat other patients. Yet, others claimed that if a physician truly detested the patient, they should refer the patient to another physician and assess their own biases.

 

4. Do doctors have the moral permissibility to treat criminals differently?

The general opinion was yes — that criminals could be treated differently. Classmates focused on the idea of an initial judgment that dictated further opinions. Others opposed, claiming that we, as people, should strive to not judge others.

 

Two additional questions (“How does a person’s perceived race, sex, LGBTQ+, socioeconomic status, age, mental disorder, criminal history, etc. affect a doctor’s perception of them? Vice versa?” and “Should someone be held liable if a doctor makes an erroneous diagnosis or misdiagnosis that leads to the patient’s death or a severe health development?”) were not discussed due to time constraints.

 

Analysis & Conclusion

The overall discontent with physicians and the doctor-patient relationship today is concerning yet hopeful. Recognition of a problem suggests an effort to improve in the future. However, expectations of a display of care may be more difficult than it seems in a busy clinical setting. 

What is alarming, though, is the attitude that we cannot control judgments and a heavy emphasis on physician autonomy.  A physician should not refuse services based on race, ethnicity, gender, religion, sexual orientation, or based on any other prejudiced attitudes. Discrimination has no place in healthcare, and addressing these issues is crucial.

Another problem was that the conversation seemed to contradict itself when classmates pointed out that time was of the essence in the medical system and the dangers of giving physicians too much power. A patient must go through the trouble of scheduling an appointment usually weeks to months in advance, make time for it, cancel anything in conflict, travel to and from the location, and pay for the appointment. When a physician refuses a patient, diagnosis and treatment may be delayed several weeks or months. 

This brings up the idea of patient rights versus physician autonomy — in what situations does one trump the other? Perhaps in future discussions, we may address this. As for now, acknowledging diagnostic and care errors made by doctors and proposing ideas for improvement suggests a changing attitude among the future generation of physicians.