Are Doctors Treating the Diagnosis or the Patient?

Tara Parker-Pope, author of "The Well" a blog on healthcare at the New York Times has started an effort with Dr. Paula Chen to have a constructive dialogue on patient-doctor relationships. It is always interesting to read the commentary, although the letters are often quite predictable, both from the patient and the doctor side..
Here is a response that I found quite thoughtful, if not profound by Dr. Stephen Taylor (It is number 65):



I was specialist in chronic pain management for 20 years.

Early on in my career I remember one of my first patients with chronic low back pain telling me that he was walking along one day and his legs just “gave out” and he fell. I told him that I didn’t understand what would have caused that and assured him it couldn’t have been his back causing that symptom.
After another 10 patients told me the same thing I began to wonder if there was an association. By the time the 20 or 30th patient described exactly the same event I was wise enough to say “Yes, that will happen in people with your kind of back problem”.
I began practice with the knowledge provided to me by my training doctors and textbooks. That simplistic knowledge lead to many tense interactions with patients because I didn’t empathize with any symptoms I had never heard of (or missed on the tests). As a physician you don’t see what you don’t understand and early on I was so focused on doing what the textbooks said that I forgot to listen to my patients.
Thankfully, over time I learned not only to listen to my patients but to like and respect them as human beings. The majority of them had suffered a great deal of abuse from doctors who were afraid they “just wanted drugs. I learned to be technically proficient and at the same time be a simple human being who understood that they had been through hell and back.
When I reached that human level of understanding of my patient’s experiences my practice became enjoyable and rewarding instead of a draining battle of wills with the people I was supposed to help.
Those poor tortured souls would always have a story to tell. If I interrupted them they would pick up from exactly the point I had interrupted them in their narrative. Early on, witnessing each patient’s compulsion to tell their complete story from beginning to end puzzled me. I thought it was simply a coincidence that every patient did it. Then I came to recognized their compulsion and their emotional urgency as coming from their need to say that they didn’t do anything wrong (which they didn’t) and that their pain was not their fault (which it wasn’t).
In fact, their continued pain was most often the result of misdiagnosis combined with poor treatment or unnecessary surgery. I learned to say, “it’s not your fault”. Frequently they would start to sob when I made that statement. From that point forward we were not just a doctor and patient. Instead, we were a two earnest people trying to find what would work to help them recover their lives.
— Stephen Taylor