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Advertisement the most sophisticated medical technology is not keeping our country well, not preventing heart attacks or cancer or the neuromuscular diseases, or chronic illnesses. What’s chiefly wrong is the very relationship that exists between doctor and patient. It is a relationship crucial to successful health care. It is a relationship in serious trouble. It is a relationship that must be improved. Doctors: Do They Care? In all fairness, and despite attitudes and actions to the contrary, doctors do care. Medicine is a helping profession. The difficulty of getting into medical school, the rigorous years of training, the interning, then residency in a hospital and finally either private practice, hospital work or academics, are not easy years. It takes a long time for a young man or woman in medicine to start earning a living. there are easier ways to prepare for a money-making career. Speak to any medical school student or intern and you find dedication a growing sense of what can and can’t yet be done, and what any fair person would see as an idealistic and genuine interest in helping people get and stay well. What happens after those early years? Some very natural things. The desire to build a stable life; a life with many of the good things that money can buy; a very typical narrowing of interests. These normal desires produce the decisions to specialize in what are lucrative fields of medicine; decisions to cut certain corners; to build group practices to share the hours; to get involved with hospitals which offer certain personal advantages. More than anything however, these changing attitudes the end of idealism are taught in medical school and strengthened during the years of internship and residency. Yes, taught. Not as part of a special course, but in the daily, weekly, yearly course of events. Taught as surely as doctors are taught to cure disease, not prevent it. Taught the same ways that doctors are taught to concentrate all energies and talents on the serious life-threatening cases, and to “go easy” with problems of chronic disorders. Try walking into a doctor’s office sometime. Announce that you know you’re perfectly healthy, sit down on the other side of the desk and ask the doctor to tell you how to stay healthy. He’ll doesn’t really know enough to help you. In much the same way, you can’t expect a doctor who has been trained to see only a part of you your heart, your digestive tract, your urinary system to suddenly see “all of you”, to even begin to recognize the problems that might be the cause of your “mysterious” headaches or stomachaches. His genuine problem as a professional starts when the tests he’s taken turn out negative. Once he realizes that your problems might not be “strictly medical”, he’d prefer that you relax and forget about them. After all, if the tests are negative, there’s very little for you to worry about. If the tests don’t reveal some sickness, you must be well. At that moment, he cannot easily help, cannot easily cure with a pill or two. He knows and he’s right that both of you expect that he can “cure” you with medication or a procedure. He knows and he’s right that he’s about to disappoint you. He already feels disappointed, and so, defensive. You’ve got questions that he can’t answer. He’d rather you didn’t even ask them. If he seems annoyed, distressed that you’re sitting there, a little distant, almost pleased when the telephone interrupts you, anxious to convince you that you’re perfectly healthy and everything’s fine; if he wants you to go home and not worry when your symptoms persist if all of that is taking place and nothing you say is getting through then you are experiencing a failure of communication. But with your puzzled insistence and growing frustration and with his defensive and self-righteous attitude blocking some or all of our six elements, how can there be a communication? Is there a Marcus Welby? One of the problems that professionals have when seeing themselves portrayed on television is the invariable distortion that makes the portrait a lie. Yet, physicians whole-heartedly embraced the concept and performance behind the success of the Marcus Welby TV Show because here was the image of the doctor presented to perfection. \(Don’t forget that it is the image Examining this “ideal” we found exactly what all of us are looking for in a physician. We admired Welby’s ability to quickly and accurately diagnose the most difficult and puzzling medical problems, and then to know exactly what remedy would work. Yet we loved him most because he cared about his patients, was always there when he was needed, always had the time to talk and listen. He was concerned and sensitive to the most personal problems. He cared enough to probe, to read between-the-lines, to understand body language. He could find the answers behind the evasions, untangle the uncertainties and confusions. He realized unerringly, that so many of the underlying problems behind the “illness of the evening” had nothing to do with medicine as such, but were worsened or caused by the emotional problems and tensions of relationships. In short, we loved Welby because he not only came to the telephone when ‘we’ called, but he knew what the problem was and was instantly ready to deal with it. Welby could communicate. Welby was perfection. But what is the truth? Doctors are not trained in the special people skills that Welby exhibited. Doctors are not trained to communicate. Not trained to talk, to ask the important questions, to sensitively seek the answers they need. Doctors are not trained to listen. They do not know how to hear what is not being said. Doctors are not trained to deal with people who suffer with chronic pain or whose medical problems are caused by emotional and psychological tensions and stress. Doctors know little or nothing about nutrition and diet. They receive only five hours of training in nutrition if that during their formal training. How then can we expect or hope that most physicians will turn out to be the mythical Marcus Welby? With their lack of information and training, it is unrealistic for us to bring our expectations along with our medical problems to a physician, but we do anyway. Somehow we bought the myth they sold; and now we’re all stuck in it. How to Talk to Your Doctor Without trying to reach the Marcus Welby ideal and without resenting the fact that it’s all a myth, we’ve got to do something about the failure of communication between doctor and patient. Why is the responsibility ours? Let’s start with the fact that there are more of us than them. Then remember that we’re the ones who need their help and that they can provide a lot of that help if we know how to get it. Look at the problem from the physician’s perspective. All he Don’t be fooled by all that technology and hardware the sonar, CAT scans and all the rest. We’re a nation sick with chronic diseases and little of that super-scientific machinery is ever necessary to help us. What is necessary is not a magic wand, THE TEXAS OBSERVER 15