Less Romance, More Communication

Several years ago I was sitting in the back of the courtroom during closing arguments in a medical malpractice case tried by two senior and very talented trial attorneys. The case arose from the death of a man who died of meningitis after physicians completely ignored obvious signs and symptoms. The man left a grieving widow and a son. During his closing argument the defense lawyer asked the jury rhetorically, "What is a doctor?" He then preceded to wax on eloquently about the challenges physicians face during their careers. I remember the defendant doctor sitting there emotionless in his expensive looking suit as his lawyer went on, painting him as a tragic hero. I also remember seeing the wife of the deceased sitting at the adjacent table looking forlorn and detached. I was sure that she wanted to be anywhere else. The doctor's lawyer, coming near the end of his closing, again asked the question, "What is a doctor?" clearly feeling that by that point, everyone had received his message that a doctor, his client, was nothing less than a hero. As the lawyer took his seat a tense silence enveloped the courtroom. The judge looked over at the widow's attorney, "Counsel?" The old attorney looked grim as he stood, a bit of anger on his face as he strode slowly to the center of the courtroom to face the jury. "What is a doctor?" he growled; "What is a husband?" His voice trailed as he looked at the jury. It looked as if he might say something else, but he didn't. He turned quietly and returned to his seat next to the widow.

Earlier this week I saw a story in USA Today announcing a new book called The Soul of Medicine by Sherwin Nuland, a former physician. The headline of the story proclaimed the apparent premise and primary subject matter of the book, that A doctor's 'Soul' is tormented by medical errors. Reading that reminded me of the closing arguments in that trial from several years ago. It bothers me too. I have no doubt that some physicians feel haunted by their mistakes. However, I have spent too many years going after arrogantly unrepentant doctors to feel anything but cynical with regard to the medical profession. I remember going to visit a neurosurgeon at his office to discuss a client of mine. I remember being shocked to see clear evidence of his god complex hanging right on his wall:



We all feel haunted by our mistakes. When any of us make a mistake that causes harm to another person the pain we feel is worse. I become deeply troubled, however, by the romanticizing of the medical professional. I feel this way because I frequently witness the impact it has. It makes physicians seem like exalted "others"; like gods among us mere mortals. This falsehood creates an atmosphere of tension, apprehension between doctor and patient. The patient all too often feels intimidated by his caregiver. This is undoubtedly a counterproductive state of affairs.

One of the reasons that we trust our doctors is that there is a perceived difference in social status between them and us. But this is not healthy. It discourages frank and open communication, which leads to poor treatment and an increase in medical errors. The more you communicate with your doctor the more you will see each other as individuals entitled to equal amounts of respect. This will encourage even more communication and openness which will lead to better care and fewer mistakes.