I find myself in a role I did not originally anticipate — intermediary. Certainly at home, I am sometimes asked to act as the intermediary between my husband and one of my children or between two, three, or four of my children as they argue, fuss, and whine about some type of real or imagined insult propagated on them by some combination of their siblings. When one of my children approaches me to ask if they can 1) have a piece of gum 2) stay up for another 30 minutes to read in bed or 3) not eat the rest of their dinner, I ask the inevitable question: “What did dad say?” Usually they’ve already received a response to their question, they’re just shopping for a better response.
Unfortunately, I’ve found myself asking similar questions of my patients. A patient comes in for a follow-up visit complaining about the specialist I sent him to. “She didn’t listen to me.” “I don’t think that he wants to treat me because I am a smoker.” “He doesn’t believe that I really have pain.” I listen to the patient’s story and then ask “Well, what did Dr. X say?” Often, there is a personality conflict or a mismatch of expectations that explains the perceived inadequate treatment.
Recently, I feel that I’ve been acting as a doctor intermediary more than I’d like to. Part of being a primary care doctor is advocating for your patients or arranging care, and I welcome the opportunity to do this for my patients. What is more challenging is to step right in the middle of a he said-she said issue between a colleague and a patient. Usually the patient will set me up a bit by declaring that I’m a great doctor and so kind, understanding, and compassionate — thereby implying that the specialist I sent them to is not.
I do think that sometimes, just like at home, there really is a misunderstanding that does warrant my intervention. Sometimes, I can act to soften the advice of a particularly blunt colleague or articulate a patient’s concern in a more direct and less emotional way. However, it is more common that my patient just doesn’t like what the specialist had to say or that the specialist just doesn’t agree with my patient about the treatment course. In these situations, it is much more challenging to act as the go-between. Sometimes I just treat my patient to the best of my ability. Sometimes I try another specialist. And sometimes I have to agree with my colleague and repeat uncomfortable advice to a patient. They often take it better from me.
I guess that this role as intermediary is an important and necessary role, but it is certainly not my favorite part of patient care.
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