The Doctor-Patient Relationship

The relationship you have with your primary care physician can mean the difference between life and death.

How’s that for an opening statement?

My parents had my eldest brother, Chris, in 1959, then 14 months later had my other brother, Andrew, and 18 months later had my sister, Mary. It was just the three of them in this tight cluster until 7 years later when I came along. Those two were full of energy, into everything, and had non-stop energy. She, on the other hand, was an introverted sensitive soul.

She also had a weight problem. For as long as I could remember she was extremely self-conscious about it. My brothers were skinny, especially Chris, and poor Mary got picked on. A lot.

It didn’t help that our primary care physician was a scary looking old man who spoke in a thick German accent and used to tease her about her weight every year at her annual school physical. She dreaded those visits and even as an adult hated going to the doctor for fear that they’d say something unkind.

Those early pediatrician visits made a big impression on her. She thought every doctor was an old man who said things like, “Vell younk lady, you ah putting on some veight, again, yah? You haff to shtop eating so many cookies.” And always in front of my brothers, giving them plenty of ammunition for teasing.

She never got over it. This was a woman who, in her late 30s, refused to go to a doctor when she clearly and unmistakably had gallstones. Incredibly painful gallstones which she insisted on treating with over the counter tylenol. They either resolved on their own or she just adjusted her pain tolerance, I’m not sure which. But it infuriated my mom who was a nurse and me who worked at a hospital. We begged her to go to a doctor but she absolutely refused. She told us didn’t want to go because she was sure they’d get on her case about her weight. Exasperated, Mom and I finally gave up.

Fast forward to the fall of 2012. Mary was suffering from some insanely horrible back pain. Nothing over the counter could touch it. She’d gone to a chiropractor, a massage therapist, and an acupuncturist, but got no relief at all. I remember her telling me that driving over railroad tracks made her see stars.

Finally, I said, “That’s it. I’m getting you an appointment to see a doctor. We have GOT to get this looked at.” A few days later, I was able to get her in to an internal medicine physician with the medical group I worked with. Although I turned my head when he asked her to take her shirt off, there was no way not to notice the giant lump she had on her breast. It was huge. Softball size huge. I couldn’t believe my eyes.

A few imaging tests later and it was confirmed. The pain in her back wasn’t a bulging disc or muscle spasms. It was stage 4 breast cancer with compression fractures in her spine. The cancer had spread from her breast, through her rib cage and into her back. There was nothing they could do. They gave her six months.

I was as supportive as I knew how to be but I had to ask why she didn’t go see a doctor as soon as she found the lump. It all came down to her fear of ridicule. She truly thought that her doctor would spend more time chastising her about her weight than addressing the lump in her breast.

Now I’m not going to blame my sister’s death on her childhood physician; at some point, we all have to grow up and do the right thing. But she was truly traumatized as little kid and those scars stayed with her well into adulthood.

Sometimes we say things and we don’t mean anything by it. We’re joking, we’re trying to inject humor in an uncomfortable situation, or we’re just not thinking about how the other person is hearing it. Whatever the reason – it matters. Doctors, believe me, we listen to what our physicians say to us. It may be a throwaway comment to you, but it’s gospel to us. Venn you vant to make a shatement about your patient’s veight, pause. Think about how that may impact their relationship to the medical field.

I loved my old PCP. There was nothing he could have advised me to do that I wouldn’t have done. And not because it was good advice; other doctors gave me the same advice, it was because I liked him. Liking him made me much more inclined to do what he asked. When he addressed issues about my weight, it was always with compassion and sensitivity

Doctors, you’re more than just the treating physician. Inspiring behavioral change doesn’t really happen without relationship. Get to know your patients. Be kind when you have to deliver some unpopular or sensitive news like needing to lose weight. The words you choose can make all the difference.