The Doctorpatient Relationship

The ability to listen, understand, explain, advise, and educate are central to the role of an internist. Without strong interpersonal skills, it would be difficult to diagnose an underlying substance abuse problem, help a patient start an exercise program or quit smoking, encourage healthier eating habits, or guide a patient's decision to sign a do-not-resuscitate order and abandon aggressive treatment. Through comprehensive history and physicals, internists spend a great deal of time with their patients — talking with them and gaining insight into their lives, their values, and their concerns. Physicians with these qualities will establish lifelong, trusting relationships with their patients.

Having long-term, continuous relationships with patients and their families is one of the best things about a career in general internal medicine. Unlike the patient of an emergency medicine physician or anesthesiologist, your patient has the potential to stay with you until old age and death. Patients trust internists with their secrets, fears, and insecurities. Internists must respect the privilege of this trust and the enormous responsibility that comes with it. They are the ones, after all, guiding patients through their illness amidst their fears. As an internist, you also lead patients through the health care system and the myriad of subspe-cialty care and treatment options. At times, they even guide their patients through family stress and turmoil. Internists' ability to diagnose and treat illness depends on the foundation of a compassionate, insightful, and respectful relationship with their patients.

Although the action of internal medicine practice is not always as tangible as performing a liver transplant, delivering a baby, or intubating a patient before surgery, it is still complex and challenging. Within this specialty, the goal of intervention may not necessarily be to cure disease, but to help the patient understand the disease and cope with its psychosocial ramifications. Beyond thinking and communicating, internal medicine requires exploring patients' cultural beliefs, recognizing the impact of socioeconomic status, educating patients about diseases and treatments, motivating lifestyle changes, and organizing multidisci-plinary care.

As an internist, you will pride yourself on your ability to solve difficult problems under intense pressure and sensitive circumstances. Take the following ex ample. An internist in private practice was evaluating a new patient in the hospital—a Taiwanese man visiting his family in the United States who became acutely and gravely ill but did not have health insurance. The patient's family members were divided on the decision of whether to continue hospital treatment versus caring for the patient at home due to financial concerns. Although the family was concerned about the patient's lack of insurance and the cost of continued care, they were also guided by cultural values to pursue every option to preserve the patient's life. As demonstrated by this case, the internist's role not only requires challenging medical management but also skills such as cultural competence, family mediation, health care economics, and a holistic view of care.

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