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Patients As Partners

The famous late 19th and early 20th century physician, Sir William Osler, said that “a physician who treats himself has a fool for a patient.” How would he have felt about patients diagnosing and treating themselves? Would he have written in support of the Journal of Participatory Medicine or against it? I also wonder how he would have practiced medicine in the “information age” when many of our patients present with a diagnosis already made, right or wrong.

I recognize that bringing Dr. Osler into a discussion set in the information age is, perhaps, anachronistic. Yet I believe he still has something to teach the 21st century on the topic of patient participation. When he advised that “the first duty of the physician is to educate the masses not to take medicine,” he offered one of the earliest lessons on a physician’s role as educator.

He also said: “The great physician would treat the patient with the disease while the good physician would treat the disease.” For me, this marches lock-step with the reality of today’s patient as consumer and active participant in the doctor-patient relationship. Simply put, it is impossible to separate the patient from a pre-conceived and often well-researched opinion — correct or not. So to treat the “patient with the disease” requires me to think of my patient as an intellectual partner.

Growing up in the late 20th century, I am comfortable with technology and remember an elective course I took in my fourth year of medical school on “the future of medicine and computer science.” The vision of the future shared by my instructors blew me away — after all, this was the first time I had even heard of the internet. Awe-inspired I found it difficult to stop talking about the new future with my fellow students, but despite my awe those instructors had no idea how far-reaching and pervasive the ready access to information would be for 21st century medicine.

For a clinician practicing medicine today to ignore the ready access to information and approach medicine in much the same way as Marcus Welby did on the black and white TVs of generations past would be a mistake. It is my experience that informed patients make happier and healthier patients. I always try to involve my patients as an intellectual partner, to do otherwise would require me to turn a blind eye to the reality of today.

Dr. Jerome Groopman, in his book How Doctor’s Think, strongly advised patients to become informed and assume an active role in the doctor-patient relationship. I agree completely and would like to share an example from yesterday’s clinic schedule with a well-informed patient that serves as a good example of the type of patient I enjoy caring for.

A 22-year-old female was working to improve her tennis game and presented with three weeks of pain on the left side of her back. She intended to continue with tennis, regardless of her pain, and asked me to evaluate her pain and see if I had the same opinion as to diagnosis and treatment that she had reached from her research on the Internet.

Ten weeks earlier she had had surgery for a trigger finger and this forced her to change her grip on the tennis racket. It was her opinion that as a result of her changed grip she had overused other muscles in her back while swinging the tennis racket. I examined her and found localized pain over some left sided muscle groups only. The rest of the exam was unremarkable.

I agreed that physical therapy would be the best option for her and made the arrangements. I added scheduled anti-inflammatory medications to her treatment plan (something she had not done yet) and furthered her understanding of the involved muscle groups.

If I had treated her pain primarily I would have advised her to stop the activity until she was better and some may argue that her pain would dissipate quicker. Perhaps, but by treating her as a partner and considering her as a person first I was able to treat her in a way that gives due credit to her role as partner in the doctor-patient relationship and will allow us to build a relationship that will serve her health as she grows older and as her problems become more consequential.

Until next week, I remain yours in participatory primary care,

Steve Simmons, M.D.

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