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The Doctor Patient Relationship: Is Informal OK?

Do you prefer a formal or informal relationship with your doctor?

Do you prefer a formal or informal relationship with your doctor?

How Formal Is Your Doctor?

Should the doctor patient interaction be strictly professional, or is it ok to talk "person to person" sometimes as well?

As a practicing physician, most of the articles I write are based on science. They are designed to relay medical information, mostly about anesthesia -- my specialty -- to people who may be looking for it.

This article is different. This is a topic I have often wondered about. I know how I feel about the topic, but am wondering how others view this issue. How formal should your doctor be in your day to day interactions?

I remember, even in medical school, being uneasy and perplexed by the teaching regarding the doctor patient relationship. Basically, you are taught (at least I was) in medical school that you shouldn't relate personally to your patients. You were to feel and show empathy for them without revealing that you actually had feelings and were never, ever to discuss your personal experiences with them.

I personally thought it was odd, especially with one of patients' major complaints being that physicians seemed "aloof" or "arrogant", but figured the older physicians knew best. So, I played along. The rationale was that you couldn't be an objective observer or clinician if your judgement was clouded by emotion. I get it to a point, but I also think emotional connections (not the inappropriate kind) can help the doctor patient interaction in some ways.

Doctors are People, Obviously

The reason that it never made sense to me is that doctors are people and DO have feelings, personal experiences, whether or not they express them. So, what was really being asked of us was to hide those things.

But, I think that this isn't always the best course of action.

For example, as an anesthesiologist, I take care of people of all ages. I am also a mom of two little boys. One of the hardest things to do as a mom is to hand your child over for surgery. But, I've done it. I have been on both sides of that interaction. My youngest boy had bilateral inguinal hernia surgery when he was 20 months old.

When I sense the unavoidable anxiety of the mom bringing her baby in for surgery, I get it. And, I break convention and tell them so. I tell the parents that I have two kids and that one of them had surgery and I do understand how hard it is to let someone take your baby for what is likely a scary and potentially dangerous (at least that's the fear) procedure. And, I have been thanked for sharing that every single time. Afterwards, the parents say that knowing that made them feel much more comfortable and reassured. I have had no complaints about my being less than formal and related to them on a HUMAN level. I also tell patients that they can call my by my first name if they are more comfortable and ask them if I should use their first name.

I will also let people know if I've had the same surgery that they are facing. I had my thyroid removed, I had a total colectomy (removal of the colon), had in ileostomy (like a colostomy) for a month, had epidurals for my babies… If it seems like it will help the patient to know these things, to help them feel like someone in that operating room "understands" the specific issues and fears related to what they are going through, I will share it with them. It helps them relax and be more positive facing their surgery.

As an anesthesiologist, I find it easier to establish trust and a good working relationship by having more informal interactions with my patients.

As an anesthesiologist, I find it easier to establish trust and a good working relationship by having more informal interactions with my patients.

The Doctor Patient Interaction in Anesthesiology

I think some of the things that work for me, work because of the unique considerations of the anesthesiologist.

An anesthesiologist gets about five to ten minutes to meet you, discuss your entire medical history, do an exam, plan your anesthetic and roll you to the operating room. Also, in this time, we like to try to make you feel more relaxed and comfortable. We definitely have drugs that will help you with that! But, hopefully our talk will help, as well.

This limited amount of time does not allow for the building of a working relationship like it would with a doctor that you see regularly in the office. It is for this reason that I think a little personal interaction works in anesthesia.

Limitations and Pitfalls of the Informal Doctor Patient Interaction

This article is not an endorsement of this type of interaction for every doctor patient relationship. It is merely a reflection on why I think it works for me, and may be ok for others in select circumstances. There are, of course, pitfalls and limitations that must be observed

  • The focus should always remain on the patient. The doc should not talk so much about themselves that the discussion is derailed from its purpose- to learn about and comfort the patient.
  • The doctor must take cues from the patient. As in all of life's interactions, we read cues from those we interact with. Some patients will want to maintain an "arm's length" or more formal interaction. This should be respected. Doctors are providing a service to a sometimes scared and vulnerable (at least in my field) "customer" and should do so, as much as possible, to the patient's preferences.
  • Introducing personal feelings and biases should only be done if it will help reassure and comfort the patient. Views of controversial subjects like politics and religion most certainly should NOT be introduced by the doctor or discussed during medical visits. If the patient invites or requests it, each situation should be evaluated carefully.
  • Informal does not mean careless or too relaxed. The information revealed by patients in the medical history is still confidential and important. To have a more "human" discussion does not preclude the need to take a careful and thorough history and make sure that the patient understands that their information will be taken seriously and with great care.

How NOT to talk to people...

Final Thoughts

No matter what type of conversation occurs between a patient and his or her doctor, the physician should always show respect. Even in more informal interactions, the patient should never feel as if the doctor is not listening or caring about what they are saying. Regardless of personal experience, feelings and opinion, the patient's beliefs and wishes must prevail in medical decision making. The doctor should not interfere with this overriding principle of medical care.

But, with that in mind, I am more comfortable having an actual conversation while learning about my patient (keeping the focus on the patient, of course).

How do you feel about this?

How Do You Feel?


Lori Colbo from United States on March 25, 2013:

Great hub. I love a doctor that is friendly, listens and asks questions and willing to allay my fears. My current PCP annoys me to death though. She is just plain odd. The first time she came in the room I was not sitting up on the table but on the cushioned bench against the wall. I was leaning back with my legs crossed and stretched out and my arms folded. After hello, I am doctor so and so, she looked at me and said "What's wrong? Why are you sitting like that? What's wrong?"

I told her nothing, I was very comfortable, thank you. She said "No, no, you do not look happy or comfortable." I sat up in a way that satisfied her and we began get to the heart of my problem. She was very friendly and somehow we got on the subject of pets. She burst into tears because she lost her dog a few months prior. I felt really bad for her, but man, it was out of my comfort zone.

The next time I saw her my leg was jiggling, a thing I do when my anxiety is flaring, and she makes me anxious. She made a big deal out of it.

It isn't that she's unfriendly when she does this, but she there is a sense of demanding I get that my body language should always meet her standards. She should have been an analyst. Obviously it is really about her own insecurities.

I trust doctors more when they are open, friendly, but know professional boundaries. Thanks.

teamrn from Chicago on September 08, 2012:

Eghad! The doc in the tape had a horrible manner and way of getting information. That gal had patience. Even though not losing her cool was to the benefit of her grandmother, he and I would have had words later on.

What do I feel about the doc/patient relationship? I feel that if my doc and I are on the same team and feel that if we're working together to achieve one goal, we'll do our best. I won't forget to leave vital info out of a history and the doc will be more at ease, so that he/she feels more comfortable asking sensitive, but necessary questions (about prior drug use, sexual things, etc).

I prefer a close relationship with my physicians; do I need to be their buddy? No. But I need to know that just like I respect that they have intelligence, I need to know that they respect my intelligence, or just plain me, as a person. After all, we both put our pants on one leg at a time.

I remember a rheumatologist who was my favorite; why? He was quite intelligent, but I later found out, that he also had lupus. He was able to 'identify' with some of the challenges I faced, without 'let's have a pity party!" He was objective about everything and didn't wear his emotions on his sleeve, but now that I know what he was dealing with, I respect him more. I felt understood, but not pampered and babied when I saw him. Au contraire, he might have been the first person to say, "buckle up and pull yourself up!"

Jen McDonough on September 04, 2012:

Wow! Great point of view. This is really helpful for the part of the patient because it makes the patient feel comfortable in dealing with their problems knowing that they have a doctor who understands what they've been going through. Thank you for sharing your thoughts!

Live Beyond Awesome

Jen McDonough

Twitter: @TheJenMcDonough

Yvonne Spence from UK on July 31, 2012:

I agree with you that sharing some of your experience can help patients relax. It helps to know that doctors understand.

I have only needed an anesthesiologist a couple of times, but both times they were reassuring, and I think that's important because you do remember it when you come round again.

Mmargie1966 from Gainesville, GA on July 13, 2012:

I think you are right on, Doc! If you spent the entire 5-10 minutes talking about your experiences, that would be a cause for more anxiety on my part if I were your patient. But mentioning that you understand how I feel because you'd been in my shoes would be comforting. It may even be distracting and ease my anxiety even more.

Thank you for doing what you do; and caring like you do!

Great hub! Voted up and awesome!

Pamela Oglesby from Sunny Florida on July 04, 2012:

I believe this is a very important component of doctor-patient care. As an anesthesiologist your have less patient contact than many other specialties, but as a patient I have found the anesthesiologist can provide some comfort before a surgery and give you a clear idea as to what to expect.

As an RN for 22 years, I have seen all kinds of relationships. The main problem that some patients and certainly some nurses have is when a doctor acts in a condescending fashion, instead of being a part of or leading the health care time. I found most doctors to have a pleasant bed side manner. I think this is a well written hub and great topic.

Marcy Goodfleisch from Planet Earth on July 04, 2012:

This is a really thoughtful and interesting topic. I've also wondered about where the boundaries are with patient/physician relations. I've seen some doctors cross the boundary a few times, but as you mention, they are people, too. Many people are comforted when they see the personal side of a physician, so finding the right balance is a fine line to discern.

Dan Reed on July 04, 2012:

Having family members that must make regular visits to doctors and hospitals, this hub has been in discussion among my family for years.

I do feel I want my doctor to stay focused and to me, if he/she is too sypathetic or emotional (which is what I think many patients truly desire) they may not be at the top of their game. Don't get me wrong. I would like a pleasant visit and do believe some lean toward arrogance a bit more than I'd like but I don't want them bawling over me during a surgery either. On the other hand when it's the "doc" whose having issues....

@ Nettlemere - I want to agree with your statement about your doctor being distracted by serious personal matter but...the fact that you wouldn't know doesn't change that they are distracted. Would you go under the knife if you knew? "Doctor's are People"

Great hub. I love the thought and discussion it creates. Voted up! Shared!

Tarantula B from North England on July 04, 2012:

I personally had a great Doctor - Paul Purser - for about 20 years, until he retired. He loved to chat, and really put his patients at ease. Annoying if you were waiting of course, but very calming. As I have White Coat Syndrome, he helped me get more accurate BP readings with his patter. To be frank, he overdid it sometimes, talking about medical school etc., but rather that than being cold. Bottom line is he did the business too.

GClark from United States on July 04, 2012:

Interesting article that raises many questions and I, like Nettlemere's answer, found that there isn't one cut and dried answer. I think the most important thing a doctor can do is to really listen to the patient and supply answers and calm any fears the patient may have. Important for the patient to feel you are actively involved with them in solving their health issues. GClark

Nettlemere from Burnley, Lancashire, UK on July 04, 2012:

Very interesting article. I couldn't vote at the end though because I think different answers apply to different situations. I can certainly see that it would be reassuring to have a doctor say I've had to hand my kids over for operations - I empathise with how you feel and when I go to the vets I like it when my vet says - this is what I've done with my own dogs. But I think there are some things I wouldn't want to know - for instance if the doctor had a family member who was ill at that very moment I might be concerned that their focus was less on me more on their relative. Pinned.

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