BLOG: The doctor, the patient, the movie

BySaleh Aldasouqi, MD, FACE, ECNU

As a clinician, practicing endocrinology in the traditional way for about 2 decades, I had once been a doctor who had practiced medicine in the old fashion, doctoring, until I watched the 1991 movie “The Doctor,” starring William Hurt, about a decade ago.

The movie depicts a previously arrogant, affluent, non-empathetic surgeon— until he was diagnosed with cancer of the larynx. His experiences as a patient transformed him 180 degrees, into a sensitive, humble, and compassionate surgeon, with utmost empathy towards his patients; a total transformation.

Knowing what it feels like to be a patient, and then practicing empathy, he began to preach empathy. He started a campaign of empathy-learning with his surgical residents.

The movie is undoubtedly a must-see for all of us involved in health care; but certainly for those of us who are interested in the patient-doctor relationship aspect of the health care system. Watching the movie myself, more than once over the years, has transformed me dramatically, and has transformed my personal attitudes, bedside manners, outlooks and philosophies towards the sacred doctor-patient relationship.

The movie was based in part on a 1988 book by Dr. Edward Rosenbaum, titled “A taste of my own medicine: When the doctor is the patient.” The movie and the book are quite different, in the storyline and details and the movie was certainly dramatized to fulfill a Hollywood audience. But the message in the movie was the same message perceived in the book — when a doctor experiences illness just like his patients whom he encounters on a daily basis do — the experience transforms the doctor’s attitudes towards interaction with his or her patients.

Such personal experience serves as a teachable moment to learn empathy. There is a fundamental difference between sympathy and empathy. Sympathy, in principle, is the emotional feeling of support for humans going through difficult time (illness, poverty, etc). Empathy is a higher emotion than sympathy; it is a deeper feeling where one puts him or herself in the shoes of the person going through a difficult time. In the case of health care, empathy is when the doctor thinks of his or her patients as if he or she was the patient. Empathy is a noble humanity trait.

Since watching the “The Doctor,” I began re-examining my bedside manners and the ways I was connecting with my patients. I steadily came to realize how important it is to transform my clinical attitudes — moving from doctoring/indoctrination into an empathetic professional.

The transformation meant to put myself in my patients’ shoes, to not be judgmental, and to focus all my time on my patients — that is focusing on patients during the office visits, by trying my best to overcome any personal, or work-related distractions.

It also involved focusing on patients’ histories, complaints, and stories that are important to them — and making those stories important to me, as well. It involved listening when a patient just wished to vent or to share anything on their mind: frustrations, sorrows, happy times and occasions. All of this has to be undertaken within the time allocated for office visits.

Ironically the allocated time is now shrinking by the day, with physicians being forced to see more patients in less time, and with the added burdens of the time-consuming and highly demanding electronic medical records (EMR). In addition to all the never-ending guidelines imposed on doctors by policy makers, insurance companies, etc. Not to mention the plague of pre-authorization.

The presumably sacred doctor-patient relationship has undergone tremendous changes in recent times. This relationship has moved progressively from the indoctrination format where the doctor only makes the shots and the patient would just do whatever the “doc” ordered, to a format where the patient is fully engaged in his or her own disease management. These changes have included all the concepts of decision-sharing, patient-empowerment and patient-education, as well as the various additions of informed consent, patient-centered care, and other modern concepts.

However, I see that the introduction of EMR into healthcare has had tremendous impact on both physicians and patients. In my academic institution, outpatient EMR has been implemented for about 15 years, the institution being amongst the pioneers in this regard, in the nation.

I am a believer that while EMR has positively revolutionized health care in some ways, it has also negatively affected physicians’ satisfaction as well as negatively impacted the patient-doctor relationship. Emerging research has confirmed this assertion.

The issue of EMR is a complicated topic, but I wish to share the story of a patient that I saw about 12 years ago. I had just joined Michigan State University, it was my first week or so at work and the patient noticed my struggling with the computer. The patient suddenly stood up, and sharply said: “Doctor, you either shut down the computer, or I am out of here!” I shut down the computer, apologized, and I continued the patient interview with a pen and paper.

I admit that since then, my skills have improved with time and I have become more able to reconcile talking with the patient while at the same time working on the computer. Needless to say, the positioning of the computer screen is crucial. In my experience, keeping the screen between the doctor and the patient ensures perfect eye-contact but this requires that the doctor be skilled in typing. It is also important to intermittently share the computer screen with the patient as needed, for the purpose of comforting the patient with what the doctor is typing and also as needed for sharing with the patient his/her labs and imaging studies.

Admittedly, I am getting better at EMR, but I will never like it. I feel that EMR is a distractor to the optimal patient-doctor relationship. In my opinion, EMR has significantly diminished the pure presence of physicians and their ability of being good listeners.

Since watching the movie and reading the book, I have experienced a progressive awakening in my mind and heart about what it should be to be a doctor and what it is like to be a patient. Was I doing the right thing by practicing a vertically controlling medicine? Was I feeling the pain and all other frustrations of my patients? Was I empathetic?

I then began studying empathy, adherence to medical instructions, and all of the co-factors interplaying in the doctor-patient relationship. I have read several books, articles and blogs written by health care professionals — who had experienced being patients, and how that transformed their professional attitudes and bedside manners.

I then began recalling several experiences in the health care system as a patient, or as a relative of a patient and I realized how difficult it is to be a patient. I have personally experienced all the health care struggles that patients go through from long waiting in waiting rooms, to difficulties with pre-authorization of imaging studies or expensive medications, to lack of empathy by some doctors.

I believe I have learned a humble amount of empathy and I owe my “awakening” to the “The Doctor” movie.