Talk Back

July 18, 2008

The new doctor-patient bond; The problem with mental short cuts

The new doctor-patient bond

When it comes to doctor-patient relations ["The new doctor-patient paradigm," June 20, 2008], better educated, Internet savvy patients are a double-edged sword. While they tend to understand medical issues better than other patients, after researching their medical problem they may think they know as much or more than the doctor. I have had patients express incredulity that I didn't know about an esoteric drug being researched in labs. The older generation seems to have less medical knowledge but is more willing to say, "You're the doctor. Do what you think is right."

Brad A. Ward, MDBend, OR

Few things are more difficult than appeasing seriously ill patients and their relatives. Still, patients do have a pivotal role in all the decision-making processes involving their illness. It's always good to look at situations through the patient's eyes, even though at times patients can be demanding or unreasonable.

M.P. Ravindra Nathan, MDBrooksville, FL

Over the years, our tools have improved, but human nature has not. Long before the Internet, I loaned books and articles to the 5 percent or so of patients who wanted to learn about their diseases. I suspect that the 5 percent figure has stayed about the same.

I do pretty well as a coach, but after a player has mastered the fundamentals it comes down to natural ability, talent, and desire. If the patient desires a hemoglobin A1c of 6.5, I'll get him there. But if I desire 6.5 and the patient desires dessert, I can't coach willpower. When the patient asks, "What else can I do to lose this weight?" I lean back and say, "Beyond following a diet for more than three days, I don't have a clue."

Charles Davant, MDBlowing Rock, NC

The problem with mental short cuts

It's no wonder doctors so easily fall into traps set by their heuristic thought processes ["From the Editor: How doctors can think better," June 6, 2008]. For years, we've been taught to use a 4th A-the aphorism-in our approach to patients. Generations of medical students and residents have had it drummed into their heads by their mentors that "if you hear hoof beats, it's probably a horse." Nonphysicians, as well, use this sort of conventional wisdom in their approach to solving life's everyday problems. But Dr. Groopman suggests that we would all do well to remember that although common things occur commonly, the next set of hoofbeats just might belong to a zebra.

Jonathan Ballon, MDChevy Chase, MD

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