Medical personality: how providers need to step up to the plate and advocate

I recently read an article by Dr. Paul Fenyves.  He is an internist in New York.  His words resonated with how we have failed in healthcare.

Medical personality is something each of us have, as a patient and as a provider.  The goal of the provider/patient relationship should be to meet the patient where their medical personality is.

On the provider side of medical personality, we have those who are autocratic and bark orders.  They say very little to patients when they are examining them, they quickly scan their chart, note an issue, write a prescription, and send them on their way.  For 50% of the population, this approach is not going to work.  There is no connection TO the patient.  Therefore, the patient is not going to take what you recommend seriously.  These kinds of providers make me cringe.  They are missing huge opportunities to get to know a patient and how to better care for them.  Patients are not going to divulge anything to you if you don’t develop a “bedside manner”.

They tend to be less compliant with taking their medications, scheduling follow up visits, etc because they do not feel a “we are in this together” connection to the person treating them.

The flip side to the above is patient centered care.  For example, I have approximately 3,000 patients.  I know many things about every single one of them purely because I ask and try to get to know them.  My vested interest in THEM, means they have more vested interest in their health.  If I hear them report a problem, I ask questions and probe further rather than just saying “oh its this, I will write you a prescription for blah blah”.  Two great examples over the last week: a kid who was not sleeping good.  Mom was concerned.  Asked questions about bedtime/wake up/stress etc.  Turns out, it was the time change.  They were waking up earlier than normal and therefore more tired during the day.  Another was having a ton of random mood swings for a week.  The autocratic approach would have been slap a mood stabilizer onto the regimen and go on.  Instead, the questions about what’s on the stress plate, school, friends, and for girls “is it the week before your period”.  Mom called a week later and said “yep, I went back and looked at calendar and this is totally happening during her period week”.  So now we know we have to tackle things differently for PMS.  These are just 2 small examples.

Another piece of patient centered care is a patient has to have a say so in their treatment.  When I finish my assessment, I recap with what the issues are that we need to address to be sure we are both on the same page.  Then I discuss 2-3 ways we can go about fixing the problem.  I give options.  I ask them what sounds doable and appealing to them.  What are they most comfortable with.  Because when you do THAT, treatment is usually more successful.  Empowering someone in their healthcare is how you achieve health not disease.  Once we settle on the med option they are comfortable with, we discuss vitamins and sleep, exercise, diet, stress reduction, boundaries, all that fun stuff based on what this particular patient is dealing with.  Therapy referrals if needed.  Patient centered care.  I may only have 10-15 minutes with the patient but if you use your time wisely and focus on the patient, you can truly make a positive outcome for them.

The reason I write about this today?  Medical personality is why our healthcare system is crumbling in our country.  Decision makers are not patient centered.  The CDC mandating masks and vaccinations failed to meet patients in the middle of the road.  Employers who mandated vaccines are NOT healthcare providers and have NO BUSINESS mandating them to a healthcare intervention.  The providers who discharged patients for not getting a covid vaccine just took away care from someone because they did not meet them in the middle with medical personality considered.  The autocratic model of healthcare has failed to realize that the ship has sailed on that kind of care.  The baby boomer generation is the last generation that will somewhat comply with autocratic healthcare.  Everyone younger than them requires a different approach.  And the majority of healthcare has failed to realize this.  What you end up with is a group of disenfranchised and angry people who hate healthcare.  They believe it is all bad, because those they have encountered so far just flat out didn’t listen, didn’t ask, and barked an order at them.  It is the same reason employers lost great employees.  They barked a mandate at them, threatened them, and the employee threw two middle fingers in the air and left.

The provider/patient relationship is a sacred one.  We have laws to keep it that way, ie HIPAA.  We cannot separate the waiting room for compliant versus noncompliant patients and be like “you sit over there Jane Doe, she’s a medical denier and refuses to take her Prozac”.  Yet we allowed businesses to do just that.  They segregated and isolated employees based on vaccine status.  People view what the government and employees did as infringement on their protected health decisions.  And they are correct to see it that way.  The mandated masks and vaccines have absolutely trashed any trust and faith that patients have in their healthcare system.  Refusal to try alternative options drove patients away.  Failure to engage “right to try” created hatred of healthcare.  That hatred is warranted quite honestly.

We need a total rebuild of healthcare.  One where medical personality is a meet in the middle with respect for the patient and the outcome is to do good, not harm.