Doctor-patient trust is a two-way road

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matayo said:
I'm currently a medical student, but my own observations in the past have led me to believe that doctors have very little patience or trust in their patients. Even abroad while working in the third world I have seen Americans or local citizens come in to visit Western physicians with high fevers, nausea, vomiting, diarrhea and other ailments and as soon as the patient leaves the doctor starts insulting the patient for being a hypochondriac. However, in my own experience abroad, nearly all Westerners do become ill, whether it's traveler's diarrhea, yellow fever, typhoid, malaria, dengue or something else. In fact, nearly 100% of travelers to Latin America, Asia and Africa DO contract traveler's diarrhea.

It seems to me that many doctors have very little respect or trust for their patients, and I find this dangerous. First, the patient is a better expert at one thing than the doctor. And that is knowing their own symptoms, exposure history and medical history. The doctor is undoubtedly a better expert at pathology, medical science and treatment options. Only when these two powers are combined can medicine truly work effectively. Imagine treating a patient who can't speak a single word? It's nearly impossible. How would you figure out what symptoms they have? How would you figure out the possible exposures? Yet as soon as patients say something so many doctors outright reject what the patient says as nonsense. Doctors must trust their patients and patients must trust their doctors, for how else can medicine remain effective?

Matthew Pflaum
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I have not had that experience. I've only seen doctors cautious to believe the patient is when they suspect they are faking pain to score meds.
 
It really depends on the doctor. I've seen many doctors while I've worked in the third world cry over the dire straits of their patients. However, it is common knowledge in the places I've been that when Western doctors come in everyone needs to go see the doctors to get medicine not because they are sick but because they could become sick later. I think this is a wonderful idea because in a lot of the remote areas free medicine is golden. Anyway I've had a lot of kids' parents come in and tell me their child had a cough and couldnt breathe and all this stuff and the kid jets off to play with the other children at shout at the other children trying to get candy from the other americans etc etc. And when I do examine them and further question my patients they have admitted that this is for the next time their child gets sick. But hey that's been my experience.
 
The chief of internal medicine at my university hospital has a saying... "the first priority of any clinical visit isn't to figure out what common illness fits their symptoms, but what they could have that could kill them before you have a chance to see them again." He's definitely a zebras man, but has definitely saved some lives in the process with that sort of approach.
 
I like that philosophy I say we all go on safari look for Zebras giraffes anything with hooves.
 
matayo said:
I'm currently a medical student, but my own observations in the past have led me to believe that doctors have very little patience or trust in their patients. Even abroad while working in the third world I have seen Americans or local citizens come in to visit Western physicians with high fevers, nausea, vomiting, diarrhea and other ailments and as soon as the patient leaves the doctor starts insulting the patient for being a hypochondriac. However, in my own experience abroad, nearly all Westerners do become ill, whether it's traveler's diarrhea, yellow fever, typhoid, malaria, dengue or something else. In fact, nearly 100% of travelers to Latin America, Asia and Africa DO contract traveler's diarrhea.

It seems to me that many doctors have very little respect or trust for their patients, and I find this dangerous. First, the patient is a better expert at one thing than the doctor. And that is knowing their own symptoms, exposure history and medical history. The doctor is undoubtedly a better expert at pathology, medical science and treatment options. Only when these two powers are combined can medicine truly work effectively. Imagine treating a patient who can't speak a single word? It's nearly impossible. How would you figure out what symptoms they have? How would you figure out the possible exposures? Yet as soon as patients say something so many doctors outright reject what the patient says as nonsense. Doctors must trust their patients and patients must trust their doctors, for how else can medicine remain effective?

Matthew Pflaum
Click to expand...

Maybe with residents occasionally, but this hasn't been my experience with attendings and docs in the private sector. More a general reliance on objectivity first. Patient comes in with vag discharge and wants an Rx for yeast infection. Yeah the patient is happily married to a local Baptist minister, but the doc is a fool if he doesn't not take her at her word and do a cultures. And don't fool yourself, patients do lie. They're embarassed and scared, they have psychiatric conditions, they malinger for disability benefits and pain meds, they lie just for no reason at all. A good clinician can distinguish this, but when in doubt be objective.
 
matayo said:
I'm currently a medical student, but my own observations in the past have led me to believe that doctors have very little patience or trust in their patients. Even abroad while working in the third world I have seen Americans or local citizens come in to visit Western physicians with high fevers, nausea, vomiting, diarrhea and other ailments and as soon as the patient leaves the doctor starts insulting the patient for being a hypochondriac. However, in my own experience abroad, nearly all Westerners do become ill, whether it's traveler's diarrhea, yellow fever, typhoid, malaria, dengue or something else. In fact, nearly 100% of travelers to Latin America, Asia and Africa DO contract traveler's diarrhea.

It seems to me that many doctors have very little respect or trust for their patients, and I find this dangerous. First, the patient is a better expert at one thing than the doctor. And that is knowing their own symptoms, exposure history and medical history. The doctor is undoubtedly a better expert at pathology, medical science and treatment options. Only when these two powers are combined can medicine truly work effectively. Imagine treating a patient who can't speak a single word? It's nearly impossible. How would you figure out what symptoms they have? How would you figure out the possible exposures? Yet as soon as patients say something so many doctors outright reject what the patient says as nonsense. Doctors must trust their patients and patients must trust their doctors, for how else can medicine remain effective?

Matthew Pflaum
Click to expand...

Hmmm,

1)Ive been told alcoholics lie..

2)A lot of times patients do have alternative motives and are trying to manipulate..

3)Its hard to make a general rule though..

4)Its part of the job or career.. You have to sift thru the B.S. and decide who is lying, dieing, crying, prying and trying..
 
matayo said:
Yet as soon as patients say something so many doctors outright reject what the patient says as nonsense. Doctors must trust their patients and patients must trust their doctors, for how else can medicine remain effective?
Click to expand...
I disagree. There are plenty of instances when you can tell that a patient has been lying to you. When they claim their sugars never went over 170 and then their HbA1c comes back at 11%, you can be fairly sure they're lying to you. Or when their drug screen comes back with a pharmacopoeia of drug classes and they claim they haven't touched anything illicit in a year. You have to remain discerning and avoid outright naivete.
 
matayo said:
I'm currently a medical student, but my own observations in the past have led me to believe that doctors have very little patience or trust in their patients. Even abroad while working in the third world I have seen Americans or local citizens come in to visit Western physicians with high fevers, nausea, vomiting, diarrhea and other ailments and as soon as the patient leaves the doctor starts insulting the patient for being a hypochondriac. However, in my own experience abroad, nearly all Westerners do become ill, whether it's traveler's diarrhea, yellow fever, typhoid, malaria, dengue or something else. In fact, nearly 100% of travelers to Latin America, Asia and Africa DO contract traveler's diarrhea.

It seems to me that many doctors have very little respect or trust for their patients, and I find this dangerous. First, the patient is a better expert at one thing than the doctor. And that is knowing their own symptoms, exposure history and medical history. The doctor is undoubtedly a better expert at pathology, medical science and treatment options. Only when these two powers are combined can medicine truly work effectively. Imagine treating a patient who can't speak a single word? It's nearly impossible. How would you figure out what symptoms they have? How would you figure out the possible exposures? Yet as soon as patients say something so many doctors outright reject what the patient says as nonsense. Doctors must trust their patients and patients must trust their doctors, for how else can medicine remain effective?

Matthew Pflaum
Click to expand...

One word: Malingering.

Yes you have to trust the patient if you know nothing about him initially, especially when it comes to things like somatoform disorders, but at the same time you have to keep your wits abound and use your knowledge to figure out what's really true. So many people go to the doctor to try to get workers' comp or sick days off by faking lower back pain.
 
matayo said:
It seems to me that many doctors have very little respect or trust for their patients, and I find this dangerous.
Click to expand...

If there's one thing I learned on my psych rotation, it's that when you think the rest of the world is wrong, it's generally not them, it's you.

Before starting med school is a little early for becoming "that guy". You may want to at least wait a semester or two before you're ready to correct the horrible flaws of the physicians above you with your keen insights.
 
matayo said:
By the way, the very fact all of you immediately tell me that patients lie proves how broken the system is! I wasn't even talking about patients lying! When I returned from Africa do you think I was lying when I told the doctor, "I could have malaria." No, of course not. I know that there are probably 300 million malaria cases every year. I have had malaria before. I was in an area that had malarial drug resistance. I missed some of my medications. I felt sick all summer. The fact I was "asymptomatic" as the resident said was completely besides the point because malaria IS ASYMPTOMATIC 95% OF THE TIME! (Just like with dengue, yellow fever, and just about every infectious disease other than HIV/AIDS but INCLUDING TB!). So...those points I gave you above...rather than being from a stupid patient who doesn't know what they are talking about...they are succinct, reasoned thoughts with accompanying scientific and medical evidence. I choose to think that every patient has this in mind when going to a physician, and indeed I believe this is the only way it can work and explains why so many cases, illnesses and maladies never have a determined source.
Click to expand...

Nobody cares about your little malaria story, dude.

We get it, you're smarter than everyone at Emory.

Move on.
 
Tired said:
Nobody cares about your little malaria story, dude.

We get it, you're smarter than everyone at Emory.

Move on.
Click to expand...

👍

You obviously come in here with an axe to grind. This isn't a discussion of the increased skepticism of doctors today or the difficulties in modern patient/doctor relationships, it's a rant.
 
PeepshowJohnny said:
You obviously come in here with an axe to grind. This isn't a discussion of the increased skepticism of doctors today or the difficulties in modern patient/doctor relationships, it's a rant.
Click to expand...

Totally.

Being an intelligent medical student, I'm sure you took the time to see someone in Travel Medicine or Preventative Health prior to traveling so that, you know, you could get your vaccinations and prophylactic meds. You decided not to see them on your return?

Bad choice, unless, you know, you were just out to "test" the docs at Emory.
 
matayo said:
...Before Semelweiss (the man in my profile image), doctors and nurses didn't regularly wash their hands...I just wanted to see how other people felt about the situation. I argued this at times with other students while in graduate school at Emory who were going to medical school and they basically agreed with all of you: Doctors should decide how to treat the patient and more or less ignore the patient because they are idiots and nobody has the patience, time or money to run all the tests for their hypochondriac patients.
Click to expand...


I hope your glib interpretation of what we all think isn't as true as you think it is. You're totally right, though - we don't order nearly enough tests here in America (that's how we're able to keep costs down), and doctors love doing permanent damage to healthy fiduciary relationships by intellectually bitch-slapping their patients.

Incidentally, after Semmelweis nobody washed their hands, either. It took a more scientific approach by Lister and Pasteur for that to come around. Yeah, he was right, but Semmelweis was seen as a bit of a malingerer and a misanthrope because he was a bad communicator and at times wasn't able to get over himself.

So I guess that's a good choice for a profile picture.
 
neuroprotector said:
So I guess that's a good choice for a profile picture.
Click to expand...

pwned.jpg
 
matayo said:
I'm currently a medical student, but my own observations in the past have led me to believe that doctors have very little patience or trust in their patients. Even abroad while working in the third world I have seen Americans or local citizens come in to visit Western physicians with high fevers, nausea, vomiting, diarrhea and other ailments and as soon as the patient leaves the doctor starts insulting the patient for being a hypochondriac. However, in my own experience abroad, nearly all Westerners do become ill, whether it's traveler's diarrhea, yellow fever, typhoid, malaria, dengue or something else. In fact, nearly 100% of travelers to Latin America, Asia and Africa DO contract traveler's diarrhea.

It seems to me that many doctors have very little respect or trust for their patients, and I find this dangerous. First, the patient is a better expert at one thing than the doctor. And that is knowing their own symptoms, exposure history and medical history. The doctor is undoubtedly a better expert at pathology, medical science and treatment options. Only when these two powers are combined can medicine truly work effectively. Imagine treating a patient who can't speak a single word? It's nearly impossible. How would you figure out what symptoms they have? How would you figure out the possible exposures? Yet as soon as patients say something so many doctors outright reject what the patient says as nonsense. Doctors must trust their patients and patients must trust their doctors, for how else can medicine remain effective?

Matthew Pflaum
Click to expand...

My question is this. You say you are currently a medical student (this was posted in April) but your signature says you are class of 2012, so have you even started school yet?
 
If you were asymptomatic and went into an ED asking for a malaria test, they were correct to turn you away. EM docs are not ID specialists, and getting an ID consult in the ED for an asymptomatic patient is going to piss off the ID specialists for wasting their time. The ID consult team is really busy at my hospital, so they don't have a lot of time to waste.
 
We get it, you're all puffed-up about this.

But seriously, I think most people are getting about 2-lines into your post and then . . . 😴
 
Confirmed.
Click to expand...

Me too. Plus as well as having no trust in our patients in America we also use PARAGRAPHS.
 
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