Doctor-Patient Rapport

By Richard Donahue, MD

Boston is a mecca for some of the finest medical education in the country. But while 20th Century medicine has unraveled the complexity of cells and organs, 21st Century medicine challenges us to unravel the mystery between our bodies chemistry, our mind’s moods, and the beauty and complexity of relationships. There’s something really special about a doctor specialists who can diagnose and treat a life threatening disease in one organ with the latest technology. For example, a tumor in the brain, pneumonia in the lung, or a heart attack. But nature is not that simple. Many chronic illnesses reside in the molecular relationships, the complexity, between our organs and the interplay of the environment on our genetics.

Then there is the way doctors think. Many specialists think about localized organs while many generalists think about interconnected systems. We all want a doctor who has technical expertise but we also want good rapport and mutual respect from our doctor. In a fascinating study where patients rate doctors on competence and compassion, the less compassionate Dr. in the white coat with a stiff upper lip was assumed by many to be more competent while the less formal more friendly Dr. was assumed to be less competent. Do we really have to trade-off rapport for competence or could our medical education system encourage, insist upon, both qualities in one doctor? My hope is that a new generation of doctors can learn to combine the science of medicine with the art of a healing rapport. Actually the best doctor patient rapport often leads to discovering hidden clues that can lead to faster and more accurate diagnoses. Perhaps we have overrated technology and under rated rapport. To a hammer everything is on nail so to organ specialist everything is seen through the eyes of that organ. I teach my medical student that doctor-patient rapport is like a dance, sometimes we lead and sometimes we follow, and sometimes we step on each of his toes.

A good doctor knows their stuff. A great doctor also knows their patient.

One measure of a doctor is how they put thoughts together and make decisions in the face of uncertainty.