Since the start of my third year as a medical student, I have been quite interested in observing how people interact with me now that I am wearing a white coat. To be more specific, I find it amazing that people do not realize that my white coat is so much shorter than everyone else’s. To me, the length of my coat should act as a warning to those around me; I do not know where things are, and I do not know what’s going on most of the time. It is this white coat however, which instantaneously turns me into a well-trusted and well-respected member of society.
Even before entering medical school, I was quite aware that society holds physicians in high overall regard. My recent experiences, however, have forced me to ask, “Why do a certain subpopulation of people, almost blindly, trust and believe what doctors say and do?”
I know that doctors make mistakes (although our training aims to eliminate much wrong-doing) and do not always act appropriately. Therefore, it is hard to understand from where this blind trust is drawn. Taking a careful look at the patients and their physicians around me, I have come to the belief that this trust goes beyond our simple definition of trust. I argue that there is something else driving this sometimes blind trust that patients have in their physicians, and that the very thing creating this driving force is the advancement of modern day medicine itself.
According to a Gallup Health and Healthcare Survey in 2010 of 511 adults age 18 and over, 70 percent of Americans are confident in their doctor’s advice and do not feel a need to seek out a second opinion or do additional research on their own. But what does it mean for a patient to trust in their physician? What is this trust composed of?
Trust can be defined as a belief that someone is good, honest and reliable. So how is a physician good, honest and reliable? Of note, a physician’s extensive training and knowledge in diagnosing and treating medical conditions within their field creates a system in which patients must rely on the expertise of their physicians. Additionally, physicians are trained to empathize with patients, respect patient autonomy, and make ethically sound decisions when it comes to a patient’s health. The profession itself expects a certain standard for physicians to be caring, honest, knowledgeable, and reliable when determining healthcare decisions for patients. Thus, a certain level of training, standards and professional expectations merge to create an ethically good, honest, and medically reliable individual — the physician — in whom patients can place their trust. But how is this trust different from other types of trust that people place in professionals? If we take the aforementioned definition of trust, we can simply apply it to many circumstances. For example, people trust their mechanic to fix their car properly. People also trust their dentist to take care of their teeth properly. They trust them because they believe that they have a certain skill set which can reliably fix a problem, and that they will do so in a good and honest way. However, the trust that I see in the hospital from some patients is different from the trust they put in their mechanic; this trust goes beyond the simple definition of trust previously addressed.
I have noted on the floors that there is a subset of patients who believe their physician is more than just good, honest and reliable. There is something else in the mind of the patient when the doctor is explaining the diagnosis and treatment for their cancer. I believe that this something else is hope. Hope that their physician will cure them and get them feeling better. Hope that their cancer will be eradicated. Hope that they will once again resume their daily lives with their families.
If trust comes from a belief that a person is good, honest and reliable, then where does a patient’s hope come from? I believe this hope comes from a belief in the power of medicine. Patients believe that the power of modern day medicine will work for them, and this creates hope. When patients hear that they have cancer, some react with fear, but for others, their initial reaction is one of hope. They cling to every word as the doctors explain advanced medical treatments, hopeful that a medical miracle lies somewhere in those words.
They believe that the all-powerful modern day medicine can help them. They may have heard or read about Gleevec, the cancer-killing wonder pill that melts away cancer in months. They may have heard of medical advancements in everything from antibiotics, to radical life-saving surgical procedures, to finding and destroying cancers with MRI and proton therapy machines. Due to medicine’s continued efficacy and progress, and for some patients, a lack of comprehension, many in society have developed a belief in the healing power of medicine.
It is a belief that Medicine (with a capital M) can cure everything — a belief that Medicine will beat AIDS, that Medicine will cure cancer, and that Medicine will allow our children to live longer than us. For some, medicine has been elevated beyond pure physiology and biological facts to an otherworldly belief in its efficacy. For some, Medicine is analogous to magic — with physicians being the revered wielders of that magic. When a patient’s hope in the healing power of medicine emerges, and combines with their trust in a physician, the patient looks at the physician through a different pair of eyes. Patients at times do more than merely “trust” physicians with their healthcare: they revere them, in the hope that they may lay their healing hands upon them and employ the magic that is modern day Medicine to heal them of their ills.
So, if hope is present in the minds of some patients when they interact with physicians, what does this mean for how they make healthcare decisions? How does this affect the patient-physician relationship? When one thinks of hope, it is mostly thought of in a positive light. Hope can give patients motivation and a will to fight harder. Unfortunately, recent events show that while the power of medicine brings hope, complacency is not too far behind.
When the power of medicine is looked upon through the lens of the sick, it prevailingly produces hope, hope that the power of medicine will cure. But, when the power of medicine is gazed upon through the lens of the healthy, it can produce complacency. Take for example, the anti-vaccination movement. If parents believe that modern medicine can tackle any disease, including those diseases which their children are routinely vaccinated against, parents are led down the path of opting out of giving vaccines to their children. If the rare disease that could potentially hurt a child can be effectively treated by modern medicine, and there remains some perceived risk involved with the vaccine, it is not difficult to see how parents make what they believe is the logical conclusion to opt out of the vaccine.
Yet another example of how hope can lead to complacency is noncompliance by patients in the care of their chronic diseases such as hypertension and diabetes. Hypertension and diabetes both do not make the patient feel “sick.” The patient may be warned about the consequences of noncompliance of their chronic disease but if there is a belief in the all-powerful efficacy of medicine to cure any consequence that may arise, there will be less motivation for patients to manage their disease appropriately when they are feeling “fine.”
The dangerous aspect of the power of medicine comes from society’s general misunderstanding of it. Patients may not understand that measles is a terrible disease and difficult to manage, even with modern medicine. Patients may not understand that very little can be done for a non-compliant diabetic patient with multiple diabetic ulcers and end-stage kidney disease. Patients may not understand that chemotherapy and radiation may only extend the life of a stage 4 cancer patient by one month. The list goes on and on. All patients hear about is how modern medicine cured this and made that patient’s life better — and even with all the malpractice commercials and questioning of physicians, the medical miracles are what the some patients choose to hear and remember. For some, medicine has been elevated beyond evaluation, diagnosis, and treatment to a revered belief in its efficacy.
The last point that I believe warrants discussion is how the aforementioned hope alters the patient-physician relationship. When this hope is factored in, it creates a mindset in the patient that is different than if they merely trusted their physician. As future physicians, we need to be cognizant of the power of this hope in some patients. Patient autonomy is often quickly tossed aside in lieu of a patient’s hope in medicine. When a complicated surgical procedure is explained to a patient, they are not comforted by the biological and anatomical aspects of the surgery, or the fact that the drug targets the HER2 receptors on their breast cancer cells. They trust in the physician and, maybe more importantly, are hopeful that the great and powerful Medicine can cure them. So, they defer to the all-powerful doctor to do whatever it is that they do to produce medical miracles. In doing so, the patient is handing over their autonomy and picking up some hope from the promise of Medicine.
As science continues to progress, become more complex, and produce more medical miracles, this hope in the efficacy of medicine will only grow, leading to further deferment of patient autonomy to the physician. Eventually, will the hope that modern medicine provides to patients drown out their trust in the physician? Will patients allow doctors to take full control of their healthcare due the complexity of the treatments and the patient’s hope that it will work? There are questions that must be present in the minds of future physicians as we progress through our training in order to fully care for a patient — not only medically, but psychologically and emotionally as well.