In case of dying patients, doctors have to do something unavoidable. Scenerios compell them to perform those, even though they very well understand that those are futile, in vein.

I humbly disagree that doctors act only for show off or for business in case of emergencies.

Doctors have much more morality, empathy & compassion inside than others indeed...

Vinod,

In a word, YES! To answer your question. @Rabiul, I believe your answer is reflective of your personal feelings about your professional behavior BUT it is not universal. It is most difficult to know thyself and nearly impossible to know the heart of others. All should be aware that evaluation by the patient is continually occurring and judgments are being made. Bedside manner and a presentation of your humanism is important to build and maintain a strong patient-provider relationship.

Regards,

Christopher

Absolutely Yes!

My teacher and mentor once told me to be conscious of everything i do and say in front of patients because they are keenly watching and evaluating me in an ongoing manner.

Just yesterday, i got a 'report card' from one of my patients.

Luckily for me, it was positive. It ended with :'Do not relent; keep up the good work'.

You are indeed lucky to have such a good teacher. I also say, keep up the good work, Babatunde!

There should be more people like you!!!!

Most definitely that is a two-way evaluation in the vast majority, if not all patients. I believe it is extremely important for a positive chemistry to exist between the patient and physician without that relationship there can be little trust and ultimately a potential loss of benefit to the patient

I very much agree with Ashley and her response. The relationship between doctor-patient is a very important element in any treatment plan with the absence of trust, there is very little expectation that the patient will get full benefit from the doctor patient treatment plan.

All sounds good on paper. Patients are getting increasingly hostile with only guarded and declining participation in clinical trials???!!

Ashley and Leisa, what do you propose to do to rectify the systematic riot?

An Editorial in the BMJ lamented 2 decades ago: If you cannot trust your own doctor, who will you trust?

The concept of "your patient" and "my doctor" is gradually dying off, and, a gigantic ethical and moral crises/morass faces the medical profession as well as the lay public. The personal touch is evaporating. Doctors try to distance themselves from their patients. They push them into RCT. Performers of RCT themselves do not have more than a vague idea of what they are doing (see RCT in migraine: A long overdue review--my project on Research gate).

I palpate a growing disenchantment of the patient with the doctor. With abysmal communication skills, AI intelligence to dissuade doctors to read texts for themselves, declining clinical skills (see a related question I posted on RG) and the hyperfocus on pennies and pence and cents, we are at the cusp of a massive downward spiral in medicine.

Any doctor who does not hold the hand of the patient (same or opposite gender) and look into their eyes reassuringly with a gentle non-judgmental smile for at least 2 minutes, and, talk about non-medical matters of relevance to the patient for at least another 2 minutes, is setting the stage for discontent. This mantra sets the stage for the "my doctor" and "my patient" tango to perfection. Patients see their doctors as counsellors, friends, priests, confidantes, guides and possessors of unique strengths and powers of healing and soothing. They do not expect you to simply fill a prescription. Those doctors who do not know what the patient expects and do not care about it, put Hippocrates to shame.

I always hold the hand (generally, the right one) of my patients in both of my hands with a gentle clasp making sure that no Ether escapes and all the electricity from the patient (that keeps us all alive) gets fully transfused into myself. Very likely most colleagues would dismiss this as mumbo-jumbo or balderdash. I am happy if cultural is pre-fixed to any such description.

If you do not hold hands with compassion, the Ether of the Universe will not flow from the patient to you. --VK Gupta

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Dear Arben,

You are right.

Absolutely.....whilst we may be evaluating our patients both physically and psychologically leading up to a procedure or treatment,we would be foolish to assume that they do not apply the same evaluations to us.

Building rapport and trust from what in many cases may be a short first meeting,often held under difficult circumstances,is an art in communication skills,which is poorly taught,and hard to gain.

Even after 3 decades in hospital medicine,I still find this to be a problem at times,and we should all remember to be able to place ourselves on the other side of the discussion at times.

@Ian

Doctors like Ian, worldwide, make the difference that may not be measurable but is invaluable. The very presence of an empathetic doctor / therapist who can offer a reassuring handshake and a concerned attitude, embrace the distress of the patient, allow the patient to speak at her/his own pace and terms, keep the interrogation to the last, build up the history of the present illness into a coherent and defensible diagnosis, and share life as a partaking of a common entity, is an awesome feature of clinical medicine.

Howsoever short, the first meeting / interview / encounter is the most important. Subsequent meetings build-up or build-down from a bar established in the first meeting.

To reciprocate over the side of the discussion is indeed a wise mode of interaction.

When this mode does not appear to be working, a lightning quick reassessment of the interaction to that point-of-time is required.

• Whereas every medical doctor listed on RG should have responded, the very few responses clarify that the intangible and currency-bereft aspects of Medicine are in a marked ebb, that culture and character--immeasurable components of our personalities and our regular-in-job qualities -- have sank to a very very low level.
• That this is a shame is an understatement. The personal doctor has vanished and the concept of "my patient" has become extinct.
• A vague impersonal interaction between the doctor and the patient is commonplace.
• In the USA, senior doctors view the first litigation distress of their juniors with a glee that matches the actual baptism or "circumcision" of their colleague.
• Doctors are wary of their patients and very very cautious of their own legal rights and wrongs.
• Doctors never stray away from the guidelines, the straight and narrow -- diagnostic or therapeutic.
• Read the distress in the attached file of a Finnish doctor reduced to a patient.
• Living with Lyme, Lykka Vartiovaara, 1995. Partake and participate in the revolting and castrating distress of being both a doctor and a patient. Take the front seat in this drama of not a single European / Canadian / American doctor willing to step out of prescribed guidelines.
• See a valuable member of our community reduced to mush due to the lack of alacrity of our own professional colleagues.
• See how guidelines cripple medicine.

Great discussion.

Great Learning,

Kahlil Gibran, the philosopher who makes every Lebanese proud and every person who reads him further enlightened, spoke of the righteousness of eating flesh of lower animals addressing the concerns of non-vegetarians. If while eating meats/flesh you are acutely aware that one day your flesh will inevitably be reclaimed by Nature, whether you are consumed by flames or interred in to the Earth. The carbon, the sodium, the calcium, the water that structures your body and really does not belong to you but to a superior power that gives life and takes it away, will return to where it ultimately belongs after you have completed the drama of existence.

I am grateful to those who have responded to this question, giving me new insights. For their sake, some of whom must be clinical doctors who have evoked their concern for emergency situations, I have a perennial solution.

When the doctor approaches a dying patient and stands by her/his bedside, the doctor must realize to the core that one day she/he will lie in the same bed. The doctor is privileged to metaphysically complete the circle of life each time this reflection hits her/him so hard that an overwhelming reverence for life and death, two faces of the same existential coin, sweeps over and within her/him. This tsunami of liberation is climaxed with a silent thankfulness for each breath and each morsel granted to us during our lifetimes--the only prayer of the enlightened. The bellows of breath keep us living, not any thing else that we might attribute to ourselves or to our ego.

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