How many patients encounter unpleasantness from doctors every day? Everyone probably knows them from their own experience, from the stories of their friends or even from media reports. Lack of empathy, subjective treatment, poor communication - the list of accusations is long. But how much do we know about the reality of the medical profession? Do we know what daily sacrifices this job entails?
Doctors encounter patients every day
A huge number of patients - those requiring treatment, those awaiting treatment, those after operations, patients in hospital rooms, operating theatres, corridors, waiting rooms. Plus the indirect patients, that is the patients' families - husbands, wives, fathers, mothers, children, sisters, brothers. All these people expect from the doctor not only a good diagnosis, competence, information, treatment, but also guidance, support, conversation, time, empathy, patience, hope...
Doctors are required to be very knowledgeable, to be able to think analytically, to combine facts quickly and to find the information they need. The doctor must also be up to date with all the latest developments in the area of his medical field. He or she is expected to communicate effectively, precisely and efficiently, with the ability to explain even very complex relationships in language that patients and their families can understand. An additional burden is the need to communicate very difficult information to patients or their families regarding, for example, a patient's poor prognosis or death. All this is compounded by the needs of patients and their families in the area of emotional support. They expect medical staff to support them during a period of immense stress, fear and anxiety associated with a hospital stay.
In addition, doctors experience considerable physical strain. This is related to the on-call duty system in hospitals, and sometimes in addition to this, the need to perform or assist in operations that last for hours and require a great deal of stamina. Doctors are often sleep-deprived and some suffer from sleep disorders as a result of their working mode. The physical strain goes hand in hand with the mental: working under stress and time pressure, under constant emotional strain. Doctors live with the knowledge that one false move of the scalpel, a change in drug dosage or a mistake in diagnosis can determine a person's survival or death. It is a responsibility that is extremely difficult to bear.
How do they bear it?
Doctors are forced to find ways of functioning that allow them to survive, that is, to protect their psyche enough to be able to continue practising their profession. The most common defence mechanism I have observed doctors employ is to narrow their perception of the patient to a 'case'. This way of reducing the patient - a living and sentient being experiencing tremendous anxiety, placing himself or herself in the hands of the doctor with complete trust - to a disease entity to be treated, allows for less emotional involvement. This is often the only way for a doctor to perform an operation, recommend a painful procedure or a difficult, unpleasant convalescence. This negatively affects the patients, who then often complain of being treated in an object-like manner.
Another mechanism that often occurs in the medical environment is 'emotional disengagement'. Doctors then reduce themselves, not the patient, to the role of a machine performing certain tasks. Working with doctors, I repeatedly asked them how they dealt with enormous stress, tension and anxiety. They would reply: "What do you mean, I go to operate because then I concentrate on the operation and stop thinking, stressing and worrying about anything else". My interviewees also admitted that they enjoy playing sports. They choose sports where they can get a good workout. High physical exertion reduces the tension they feel for a while .
On the other hand, in direct contact with patients, doctors very often use avoidance. They do not have the strength to confront the fear, anxiety and suffering of patients, so they do not talk about problems directly, they key in, they do not call a spade a spade and they use understatements. Maintaining only superficial contact, they try not to raise difficult subjects, thus keeping silent about a lot of important information. They also refrain from expressing their feelings. This is in line with the conviction from medical studies that they should rely only on their knowledge and intellect, handle any situation on their own and not show weakness.
Does this have to be the case anymore?
The problems in the doctor-patient relationship have long been realised. Since the 1950s in the world and since the 1980s in Poland there have been so-called Balint groups. Group discussions are an opportunity to take a close look at the processes of communication with the patient, a way to better understand them. A safe environment, in which confidentiality applies, is conducive to an open exchange of experiences, reflections, expressing one's own feelings. This, in turn, allows problems to be seen in a new light, which can lead, for example, to the doctor becoming aware of his or her own limitations. The aim of the meetings is to increase the effectiveness of the treatment and minimise unnecessary conflicts. Participation in a Balint group can prevent professional burnout, increase doctors' satisfaction with their own work and inspire them to change their behaviour towards patients and even change their attitude towards them.
Other helpful solutions can be psychoeducation workshops and training in the areas of interpersonal communication, assertiveness, stress management and constructive conflict resolution. These can, on a par with Balint groups, bring improvements, but regularity and broad impact are important. A system of workshops and meetings involving doctors of all specialities and the rest of the medical staff would be valuable. This would provide an opportunity for the change that patients have been waiting for for years.
