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The Therapeutic Magic Of The Physician Patient Relationship: Part 1

Posted Dec 23 2008 1:59pm

 

Stanley Feld M.D.,FACP,MACE

A positive physician patient relationship has magical therapeutic powers.

I believe I can best describe it with two very difference personal experiences.

Both are reminiscences of events that occurred long before I was a physician. Both gave me incite into the power of a physician patient relationship and stimulated my desire to be a doctor. One experience was doctor related, the other was teacher related.

During 30 years in private practice as a clinical endocrinologist I always tried to treat my patients remembering the therapeutic effect of those experiences. Those experiences had magnificent healing powers for me.

The first episode occurred when I was a first grader in the Bronx. The year was 1946. In those days being left handed was thought to be a curse. My first grade teacher forced me to write with my right hand to avoid the destiny of the curse. I remember the difficulty I had writing with my right hand. I was forced to persist. I made many mistakes and had great difficulty learning to do anything academically.

I had difficulty learning anything new, especially reading and arithmetic. I thought I was a pretty smart kid. My impression was confirmed by my father when he continually told me I was a smart kid. I was told not to listen to my teacher’s impression of me.

I was never a difficult child at home but something agitated me in school. I remember being a difficult first grader. My teacher considered me a trouble maker. She did not understand why I did certain things.

Finally, my teacher called my mother in for a conference. I was forced to listen to the conference. The teacher told my mother she was positive I was a disturbed child and needed psychiatric attention. I was behind in reading, writing and arithmetic and was not adjusting socially. She told my mother she should act immediately before I was permanently damaged. She said if this continued I could be expelled from school.

My mother was beside herself. She did not know what to do. I felt her anxiety but did not know what to say. I did not know what a psychiatrist was. I was told we could not afford a psychiatrist. I thought the solution to my problem was to be allowed to write with my left hand. No one would listen to me. Everyone, including my parents believed that left handed people were cursed.

My father’s boss suggested we go to Dr. Schultz, a family practice doctor, in the West Bronx. I remember the look of Dr. Schultz’s street. It was tree lined with two rows of attached single family houses with and concrete steps. We lived in a 4 room apartment in a walkup apartment building on Bristol Street across the street from the Boston Post Road movie theater.

The first room we entered was a living room with couches used as a reception area. At six years old I was impressed and terrified. My mother was just terrified.

Dr. Shultz’s office had a desk, a few chairs and a mirror behind the desk. He asked my mother what was wrong. She repeated the teacher’s report almost verbatim. He asked some detailed medical history and took notes. When he finished he turned to me and asked me what I thought was wrong.

This is the first time anyone had asked me to express my opinion. He saw I was nervous and frightened. He calmed me down and told me usually the patient can tell him what is wrong if the patient is given a chance to express himself.

I told him that the teacher made me write with my right hand because left handed people were cursed. He said he heard that was a common superstition but there was no proof it was true. He then asked me to write my name and my brother’s name on a piece of paper with both my right and left hand. I did and he said “son, there is nothing wrong with you.”

My mother looked in disbelief. He then picked up the paper and showed it to my mother. She still did not understand. He then put the piece of paper in front of the mirror. My right handed entry was legible now and the left handed writing which was legible at first was now backward. I was mirror writing.

He told my mother that that problem was the result of the strain put on me being forced to write right handed. After I was permitted to write left handed for a while my ability to write, read and do arithmetic would straighten out. My behavior problems would also vanish. He suggested that my mother listen to my complaints in the future. He wrote a note to the teacher ordering her to let me write with my left hand.

Then he got up from his chair, came over to me and gave me a big hug. He also told me to show everyone they were wrong about me. I felt like a million bucks. All the tension left my body. I felt I could achieve anything.

There is no question in my mind that this approach to medical care and the therapeutic effect of the positive physician patient relationship saved my academic life.

The pressures on physicians today to see more patients, to test for everything so you do not miss a diagnosis, the lack of reimbursement for cognitive therapy, the constant threat of financial penalties and continuous assault on physicians’ judgment has served to decrease the ability of physicians to relate in a human way.

“There is considerable healing power in the physician-patient alliance. A patient who entrusts himself to a physician's care creates ethical obligations that are definite and weighty. Working together, the potential exists to pursue interventions that can significantly improve the patient's quality of life and health status. “

The simple way to put it is medical care has and is being commoditized and dehumanized. These attributes are the common denominator to patients’ complaints about the medical care system in 2008. I cannot justify or condone physicians’ behavior.

Our healthcare system has to change. It must support the humanizing elements or the patient physician relationship. It has to nurture mutual trust rather than distrust between patients and physicians. A healthcare system that supports distrust, physician and patient penalties and adversarial interrelationships does not permit this princely profession to offer the kind of care physicians are capable of.

President-elect Obama and Tom Daschle imposing more bureaucratic controls on the healthcare system is not the answer. It is clear to me that the consumers and their needs must drive us back to a more humanized system.

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