Who Needs the Relationship More: Doctors or Patients?

Pamela L. Wible, MD

Disclosures

August 23, 2017

In This Article

Realities of Doctor-Patient Relationships

It's true. Doctors have thousands of relationships with patients, and patients have a few key relationships with doctors.

"We are here to serve our patients," claims psychiatrist Lamis Jabri, MD. "Of course we need them too, but we can always find new patients. Our patients can't always find new doctors."

"I suspect the patient needs the relationship more. At least, some patients do," says one anonymous physician, who explains, "I'm someone who doesn't seek 'a relationship' with my personal physician or with my patients. As a patient, I just want to get in, get business taken care of, and be done. Sure, I don't want a jerk, but this touchy-feely stuff is not important to me."

As screen time and throughput increase, many docs don't have a free moment for any relationship. According to emergency physician James Speed, MD, "Patients benefit from continuity of care, although technically the question has no logical meaning owing to multiple false premises. The 'BIA'—bureaucrats, insurance people, and attorneys—doesn't allow doctors to benefit in any format except remuneration, and they are trying to take that away. In my world, the emergency department, we never get a chance to establish a relationship anyway."

One doctor laments, "I'm too exhausted to need or provide any relationship." 

"Who needs who more?" asks psychiatrist Lisa E. Goldman, MD. "It had better be the patient, or I'm in big trouble. I have to be getting most of my emotional physical and psychological needs met outside my relationships with my patients. And it isn't realistic or possible to get one's spiritual needs met from my patients in concrete reality. But in the abstract, my patients most assuredly do nurture me when they accept the help I am offering."

"It is my job to not depend upon the love, approval, or respect of each patient, although I do welcome it when it is there," Dr Goldman says. "I have needs too. But it's not the individual patient's responsibility to meet these needs. If it were, I would be running the risk of exploiting my patients."

Arguments for Doctors Being Needier

"I think the doctor needs the relationship more," explains an ob/gyn who requests anonymity. "My reasoning is the patient can change doctors as easily as changing socks. You are but a small fraction of their patient's life, even if they think you are the greatest doctor on earth. Doctors need and desire the relationship—that is why many went to school—to help people, and in that 'help' they envisioned a relationship."

"One of the reasons I won't do clinical medicine anymore is because I would pour myself into my patients—anything they needed, whenever they needed it—at the expense of my family and my own life," says this doctor. "Then they switch to your partner, or change practices altogether, or file a malpractice suit. There is real heartache potential if you are seeking friendship and a reciprocal level of commitment."

"Doctors become frustrated when they work so hard for patients who may take a passive approach to their own health—and put even less effort into developing a relationship with their physician," explains psychiatrist Jonathan Terry, MD. "Most patients don't want to be patients, but every doctor works his or her tail off to earn the privilege of having this professional relationship."

"The physician needs the relationship more," says internist Rex Mahnensmith, MD. "That care is genuine, heartfelt, and heart-based, and not mechanical, not robotic, and not driven by productivity measures. In fact, it is the relationship that protects patients from one-size-fits-all medicine and safeguards physicians from malpractice suits. Patients don't generally file lawsuits against doctors with whom they have great rapport—even if the doctors make a mistake."

Relationship-driven medicine is safer and more fulfilling than production-driven medicine. Family physician Rebecca Gallagher, MD, elaborates. "Without a good, high-quality relationship with their patient, the doctor cannot fully share or express their talents and gifts. I feel this is essentially what leads to extreme discontent and resentment in a physician, leading ultimately to a deterioration of their identity and well-being. This starts the spiral into anxiety, depression, and loss of self-esteem and self-worth."

Arguments for Mutual Dependence

"Relationships are not a contest. You cannot have one person in the relationship without the other," says family physician Chris Hatlestad, MD. "Both parties have different needs, expectations, and roles. Most of these—income and healthcare primarily—seem clear in a doctor-patient relationship. Clearly, some patients need more reassurance, guidance, compassion, empathy, or just a sympathetic ear beyond the mechanics of diagnosis and treatment."

"Without a relationship, both parties suffer," says family physician Steve Ames, MD. "The patient will not get compassionate, connected care. The doctor will wither and be stunted in his or her ability to truly give care that is healing for the patient in physical, mental, and spiritual ways. The joy of practice evaporates without the relationship. Patients and doctors are being separated and pitted against each other. The relationship is being destroyed by population management and withdrawal from individualistic care."

"The doctor-patient relationship is special and a unique form of attachment having to do with suffering and illness, health, healing, and death," says a doctor who wished to remain anonymous. "One might assume that the patient needs the doctor more because the patient is ill, vulnerable, and dependent. Without patients, however, doctors have no purpose. In addition, they are frequently not so good at the rest of life and, for a variety of reasons, fit best in the peculiar niche that is modern medicine. Of course, this is changing and becoming postmodern medicine, which has the doctors upset and depressed."

"Both need each other," states general practitioner Tonya Townsend, MD. "It's like asking, 'What is more essential for a painting—the canvas or the artist?' The healer needs the sick. It is symbiotic in a sense."

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