Physician-Patient Relationship: Sacred and Sacrosanct

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There are many relationships we build at work in our entire lifetime. Some are good, a few are not, and many are somewhere in between. But of all the relationships we are fortunate enough to build, there is no relationship more valuable and gratifying than the one between a physician and a patient.

Consider this possibility. Would we, on day one of an acquaintance, entrust our finances to our bank manager or our CPA? Would we trust our house to a brand-new electrician or plumber at first encounter? Would we purchase anything at the first sight without planning for it or doing extensive background research? These examples are all inanimate aspects of our life that can be dispensable, although we would not want to.

The Indispensable Human Life

Now, how about the human life, which is indispensable? That is exactly what happens in a physician-patient relationship. It is the unfortunate call of a disease that brings a physician and patient together. Here they are—two humans—strangers one minute, and the next minute, they are bound together by the tentacles of disease. The physician and patient meet as strangers under the umbrella of fear and anxiety of a disease and are expected to forge a relationship. Patients are supposed to place their lives and entire trust in the good intentions of physicians, but they are still strangers until that moment of their first interaction. This is particularly more compelling for those visiting a surgeon. Here are patients meeting a surgeon for the first time with the knowledge that this person might potentially use cold, sharp metal to cut them open.

“When we treat the disease, we heal the body. When we treat patients’ fears, we heal their minds. When we treat the person, we heal the soul.”
— Chandrakanth Are, MBBS, MBA, FRCS, FACS

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Placing the trust of your life in the hands of a total stranger is a tall order, even for the patient blessed with fortitude. But that is exactly what happens on a daily basis in our field, and we are so fortunate to be the people patients place their trust in. With some exceptions, most patients do place their trust in us, and this is the most gratifying part of our job. As physicians, we should never betray that trust or forget the honor and privilege of receiving that trust.

Unintended but Appreciated Benefits

There are several benefits that come out of a sound physician-patient relationship. You gain access to the innermost recesses of a patient’s life. Doors in the life of strangers are opened to provide clues to the disease or their treatment. These clues sometimes not only help you to formulate better treatment plans, but also help to heal minds.

And then you get the unintended but very much appreciated benefits of being part of some of the wonderful events of a patient’s lives. For example, take the patient with pancreatic cancer whose only goal in life at that time was to walk his daughter down the aisle at her wedding. Right at our first and subsequent meetings, he had his mind singularly focused on his daughter’s wedding, even as we are going over the details of his disease and the Whipple operation. Every step of his treatment had to be decided based on how it synchronized with the wedding date.

On the very first postoperative day, he remarked that he would be able to make it to the wedding after all. A few months after his Whipple came the invitation and later the wonderful wedding photographs, showing the patient with a beaming smile. He did get to walk his daughter down the aisle, which was priceless for him. To see that unbridled joy in a fellow human resulting from what we would consider a routine part of our daily job is equally priceless to us.

Bright Attributes Amid Dark Moments

In addition to sharing wonderful moments, we also get the privilege to interact with some amazing human beings. Some of these patients may be going through the darkest moments of their lives, but they continue to display some of the brightest human attributes. Human nature occasionally tends to be tardy to compliment but ready to criticize. For some, even in the best of health, compliments can be hard to come by. This can become even more difficult for those going through periods of sickness. The ability to compliment a fellow human being is a gift, and to be able to do that even when you are not well is a blessing.

Take the patient who we were fortunate enough to snatch away from the imminent jaws of death. After nearly seven laparotomies elsewhere, he came to us in the extremes of both sickness and uncertainty of life. After the operation, he spent several weeks with us and recovered well enough to be discharged from the acute care facility. He had subsequent multiple admissions, but each one less serious than the original one—to the point that he was able to go home.

Despite the gravity of his sickness, the patient had a ubiquitously ebullient attitude at all times. Even at the ungodly hour of surgical rounds in the dark of night, he always had a smile and more importantly a compliment about my tie. One day, I noted that my daughter had chosen my tie. Since that day, he always enquired about who chose my tie for the day. The compliments were always more effusive if it was my daughter. Years may have gone by, but he never forgets to ask that question about my tie in the clinic.

A good physician-patient relationship can be formed even in less-than-ideal circumstances of communication. Take the patient who came close to death for several months of critical stay in the ICU. The only reason this patient survived was that we avoided an operation.

During the extended period of intubation, I used to have multiple discussions with the family members. My interactions with the family members far exceeded that of my interactions with the patient due to the predicament of intubation and sedation. Nonetheless, the patient did well and went home. Even though I spent far more time with her family members and may not have communicated much with the patient, her generous gratitude at every clinic visit was genuine.

Beyond Just Treating Patients

The benefits of physician-patient relationships can be enduring and continue to remain gratifying. The unfortunate diagnosis of a disease initiates the physician-patient relationship, but there are many fortunate aspects to this relationship. A good physician-patient/family member relationship goes beyond just treating the patient. It supersedes relative value unit requirements, compliance standards, quality metrics, and national hospital rankings. There is no quality metric that can capture the intangible human goodness of this relationship. It goes beyond the four walls of a hospital. It has several aspects that make it so unique, and no other relationship can come close to it in terms of enduring gratification.

When we treat the disease, we heal the body. When we treat patients’ fears, we heal their minds. When we treat the person, we heal the soul. A good physician-patient relationship treats all three. A good physician-patient relationship is sacred and sacrosanct. Let us continue to teach and practice it. Let us not allow any outside entities or the beneficial and creatively destructive forces of gnarling technology to redefine or dismember it. And, for those who are lucky to experience it, let us cherish and enjoy it. It is one of the greatest and lasting joys of being a physician. Strangely enough, in a day when much of what we do as physicians seems to be controlled by others, it is one part of our job that is entirely under our control, so let us not lose it. 

DISCLOSURE: Dr. Are reported no conflicts of interest.

Dr. Are is the Jerald L & Carolynn J. Varner Professor of Surgical Oncology & Global Health; Associate Dean for Graduate Medical Education (DIO); and Vice Chair of Education, Department of Surgery, University of Nebraska Medical Center, Omaha.

Disclaimer: This commentary represents the views of the author and
may not necessarily reflect the views of ASCO or The ASCO Post.