Physicians should hear those alarm bells

"Hey, Doc! How ya doin’? Look at how great this scar healed up! You did a fantastic job! Man, I LOVE this place! You look great! What are your kids up to these days? Did you lose some weight? Give me some more good news!"

I laugh and hold up my hand, but he is irrepressible. Had we initially met socially rather than because of his cancer, I realize that we would have quickly become friends. During his office visits, I can expect stimulating conversation, new stories about his family and a shared confidence or two. I really enjoy his appointments.

And that worries me.

There are a couple of reasons for my concern. First of all, despite the fact that physicians should care deeply about the health and well being of all of their patients, the therapeutic relationship is not based on "friendship." Physicians must be vigilant and objective in ways that friendly relationships can disturb.

Second, physicians need to provide care with justice. All patients who come to us, whether they look like us or not, deserve the same quality of care. Physicians must be scrupulously fair in the equitable distribution of their time and attention. It is clearly unethical to spend more time with a patient simply because they remind us of ourselves.

Medical blogger, Kevin, MD, has a link to a New York Magazine article that interviews several anonymous physicians.

These doctors rovide blunt, sometimes disturbing observations on everything from picking a doctor to medical mishaps. In response to a question on how patients can get doctors to pay attention to them, a gynecologist responds, "The truth is, we’ll spend more time with patients we like. We’ll joke with them, we’ll laugh with them. You have fun with patients you like." He implies that being charming pays benefits. Interestingly, neither the interviewer nor the other physicians challenges him.

Someone once told me, "It often seems that the worst medical care is given to VIPs and to doctors’ families." It certainly seems to be true at times. Corners get cut. Potentially embarrassing critical questions are left unasked. Treatment is too hesitant or too aggressive. In an effort to be both a physician and "something more," things can happen. 

My easygoing, friendly patient sits grinning at me. I truly am happy to see him, but the alarm bells go off in my head. I keep a "safe" distance, keep to my checklist, and try, once again, to overlook how much fun it is to see him.