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That Dr Rob article

A lot of people are commenting about this article, a doctor's letter to patients with chronic disease:


I get that Dr Rob means well and I like that he admits doctors are scared by chronic conditions and by the fact that many patients with chronic conditions know more about their conditions than the doctor does. I do think respect goes a long way toward improving communications between people. However, I don't think it works when he tries to pretend the doctor and the patient are equal:

"just like you know your disease better than any doctor, I know what being a doctor feels like"

"we have worked very hard to earn our position; it was not bestowed by fiat or family tree. Just as you want to be listened to, so do we."

"The best care happens when a doctor understands the patient and the patient understands the doctor."

In a typical doctor-patient interaction, the doctor and the patient are not equal. The doctor has much more power. And although Dr. Rob addresses that the patient is suffering, he completely ignores the power imbalance in the post.

The post got a great many comments and he engaged a lot with the comments trying to explain where he's coming from. In the comments, he sees people saying stuff about the power relationship, but he doesn't get that the power relationship is systemic and what that means. He says stuff like "docs are insecure about their position of power," and he talks about how the good doctors wish the bad doctors would go away. But he doesn't understand that this power imbalance inevitably affects the doctor-patient relationship even in the case of good doctors who mean well.

At a NAAFA conference a few years ago I went to a talk that really hammered home the point that the medical system is a system, and in that system patients are roles and not individuals, and therefore it is very difficult to get your needs met if you have individual needs that the system doesn't have a systematized solution for. (Case in point: After the OH had an operation to install his cochlear implant, the hospital staff persisted in trying to communicate with him by talking, although he had a bandage on his head and was completely deaf.) I wish Dr Rob could have gone to that talk.

This entry was originally posted at http://firecat.dreamwidth.org/683867.html, where there are comment count unavailable comments.


( 8 comments — Leave a comment )
Jul. 25th, 2010 07:14 am (UTC)
i quite like doing things that my doctor didn't approve, just to restore the power imbalance. on reflection, i wish i had discussed my eye operation with him instead of presenting it as a fait accompli, not that he would have dissuaded me, but it didn't work and it did cost a fortune.
Jul. 26th, 2010 01:39 am (UTC)
I wasn't aware of the article; thanks!

And the systemic power issues are exactly what I struggle with most; it's not really possible for a doctor to set those aside. Whether he or she likes it or not, prescriptive power and gateway control for testing and other doctors is a lot of power, and I always know they have it (and I resent it).
(no subject) - shehasathree - Jul. 26th, 2010 12:56 pm (UTC) - Expand
Jul. 26th, 2010 07:38 pm (UTC)
Yes, and the well-informed patient with a chronic disease, especially an unusual one, probably knows more than a GP about their particular condition, because a GP simply can't keep up with everything.

(I like your journal; adding you as a friend.)
(no subject) - shehasathree - Jul. 27th, 2010 02:41 am (UTC) - Expand
Jul. 26th, 2010 11:37 pm (UTC)
I didn't so much have a problem with the stuff you quoted, but I was irritated by his advice of "don't come on too strong." If you have something really important to say (and discussing your health with your doctor would be one of those times), you can't afford to worry about how you're coming across, as long as you're not crossing the line into being rude.
Jul. 26th, 2010 11:51 pm (UTC)
Yeah, and "don't come on too strong" is useless for anything except worrying that you are.

(Added you as a friend. Babylon 5 fans should stick together.)
Jul. 27th, 2010 12:31 am (UTC)
Cool! *added you back*
( 8 comments — Leave a comment )

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