The Patient Physician Relationship

During the many years that I have practiced rheumatology, I have noticed new and constantly changing roles for each partner in the patient-physician relationship. Today, the patient is the dominant partner and the physician has become relegated to a less authorative role.
The noun, doctor, is defined as a "teacher, a learned man." The verb to doctor is "to do what is suitable and to teach." A patient is defined as "anyone receiving care or treatment." The adjective "patient" has at least five definitions: 1. bearing or enduring pain or trouble without complaining or losing self-control, 2. refusing to be provoked or aggravated by an insult, 3. calmly tolerating delay, confusion or inefficiency, 4. able to wait calmly for something desired, and 5. steady, diligent and persevering. By these definitions we need a doctoring Doctor relating to a patient Patient to form a positive successful merger for best possible results.
The physician brings into his pratice his heart, soul, mind and body. He still must accept medicine as his prime goal in life when he accepts the title of Doctor. He must be an ethical, moral, charitable person who is involved with his family and community.
Many years ago, I saw a young girl in consultation who had seizures, was taking Dilantin, and has all the classical findings of lupus erythematosus including rash, sun-sensitivity, joint swelling, pericardial and pleural pains, fever, positive LE cell test, high sedimentation rate, anemia and fatigue. One unusual finding was the presence of hives over her swollen joints on the back of the hands. Three days later, I attended the American Rheumatism Association meeting in Hollywood, Florida, and heard Dr. Lawrence Shulman describe drug-induced lupus from Dilantin. After discussion this with Dr. Shulman, I immediately went to the telephone, called the referring neurologist and told him to stop the medication. I informed him that the serious prognosis that we had discussed only a few days before was not likely going to be true.
Everyone would have prefered to be swimming, but I and 1,000 others were listening to this paper.
The patient has many responsibilities to maintain the best mental and physical health possible. He must play an active role in his medical care. He must learn about his chronic disease, relate his fears, frustrations, goals, share in decisions, inform about adverse effects and investigate problem solving methods to achieve his desired goals.
There are many fators that impede progress toward these goals. Five factors to beware of are: FEAR, FAMILY, FRIENDS, FRAUD, AND FAKIRS. To counteract fear I give the classic answer that the only 100% fatal disease is LIFE, and that lupus is 100% less dangerous than life. Family and friends become problems which are correctable with proper education and good communication, so that we can catch those who prey on patients with chronic diseases. Fakirs are harder to eliminate. These people actually believe what they say. Someone inadvertently does something and attributes a successful chance improvement to one of these accidental occurrences and promotes this.
Five positive factors are: FAITH, FAMILY FRIENDS, FOUNDATION and FEDERAL AGENCIES. Fatih includes faith in themselves, faith in their physicians, faith in medical science, faith in nature, faith in the future, and faith in religion. The family and friends are positive F's too, when they are able to participate in decisions, and to help but not overwhelm the patient with their own fears and problems. Programs such as Significant Others help mobilize thes resources. In addition, the non-profit Lupus Foundation is helpful. The last F is Federal Government which provides Medicare, Food and Drug Administration, Social Security and financial help. The National Institute of Rheumatic, Musciloskeletal and Dermatological Disease is headed by Dr. Lawrence Shulman and is doing valuable research.
When physicians and patients communicate, the patient often becomes the teacher nad the doctor becomes the student. Many applicable research studies are resulting in more effective results.
My greatest fear is that the growing financial powers of insurance companies, government agencies, and others will control and change this important partnership between patients and doctors. The quality of care may decline without this communication.
In summary, patient-physician relationships require a patient Patient working with a doctoring Doctor in a good active mutual relationship. Success relies on a dedicated physician who is satisfied with his work, and a patient satified htat he understands his disease, has accepted it, has coped with it and has taken charge of his life by using all of his valuable resources.