Ophthalmology Medical Internship Reflection #1

Contrasting Styles of Doctor-Patient Interaction

Patient interaction. This phrase features prominently in every pre-med class, lecture and discussion. Students are encouraged to volunteer so that they can get that interaction early; they’re given lessons on what they should and should not do. During a volunteer shift at the James, I recently found a book, written by and for doctors, advising them on how to take cultural background and beliefs into their interactions. During my first rotation (Glaucoma), the two doctors I shadowed had markedly different styles of interaction, which led to, arguably, different tones for the appointments.

The first doctor I shadowed, Dr. X*, functioned very much as the “authority figure” doctor. The moment she walks in the room, she takes command of the appointment. She usually begins with asking how the patient is, and then reviews the patients’ record, usually in silence. In my opinion, some patients seemed comfortable with these period of silence, while others seemed a little unease with it. During examinations, her actions were very business-like, with discussion focused purely on the appointment itself, rather than any small talk. At the end of the appointment, Dr. X would ask if the patient had any questions. Most patients would follow a similar format: a question, followed by a story either further explaining their concerns, or their day and its changes. Dr. X often interrupt this follow-up, going straight into answering the initial question, even when it was obvious that the patient wished to continue speaking/telling their story. In general, Dr. X’s visit times were shorter than her counterpart, Dr. Y.

Dr. Y was the second doctor I shadowed, whose approach was more oriented toward the “personal connection.” Small talk was much more prevalent, whether it was a comment or inquiry about family, school, etc. Often, he would be the first to offer this information as well, recalling information shared from past visits. This small talk usually occurred during examinations or before examinations, and was more bidirectional, with the patients contributing just as much, and were rarely interrupted. The patient record was reviewed outside of the room, leading to less periods of silence and larger percentage of time focused on the patient. Overall, these factors together made the appointments longer in length, but also gave them a friendly, casual tone.

Some of the differences, most likely, stemmed from logistics. For example, Dr. X’s access to a computer between appointments seemed much more restricted than Dr. Y. This, most likely, was the reason for the need to review records with the patient in the room, which sometimes resulted in patient unease. Other differences may have been attributable to personality differences, time restraints or numbers of patients.

Each style seems to have its pros and cons. I would argue that Dr. Y’s style appeals to those with a more patient-centered approach—it’s more personal, especially with the exchange of small talk and conversations outside the medical visit, and allows both doctor and patient to reveal a bit more of their personality. For many individuals, this can create more of a bond between the two, and lead to a better working relationship. Personally, this is the style that appeals to me. If I were the patient, I would enjoy the small talk and lack of interruptions, even if it lengthened the appointment, as it would make me feel like the doctor cares about me personally, rather than just as his 4:30PM patient. Others, however, may feel that this style is too familiar or casual. My father, for example, would much prefer Dr. X’s approach, due to its more clear-cut roles and expectations. The simplicity of the conversations—focusing largely on examinations, relay of information to patient, followed by treatment plan and future directions—makes it easy to follow and focus on the needed information. Dr. X’s style also clearly showcases her as a completely confident authority, which can assure patients of her competency and lead to better compliancy. Compared to Dr. Y’s patients, Dr. X’s patients were less likely to question or argue about the treatment. Dr. X’s methods also lead to shorter appointments, which would allow her to reach more patients in the same amount of time.

As a doctor, your job is to help your patient—to make them healthy and keep them as such. By these standards, the strength of a doctor should be focused entirely on the well-being of their patients. Yet, a doctor whose patients are healthy, but unhappy/hurt/insulted with how their doctor treats them, is not considered a good doctor. This shows the importance of patient-interaction. But should the patient’s feelings toward their doctor matter as much as if the doctor helps them recovery? I would argue yes. Having good patient-doctor repertoire is not only a good business model, as I’ve sometimes heard it described. It, more importantly, leads to better confidence in the physician, better compliancy, and a more at-ease patient. The Glaucoma rotation introduced me to two different, but effective, ways to achieve good patient-doctor rapport.

*All names have been changed for privacy purposes

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