The Paradox of the Doctor-Patient Relationship: A Medical Student’s View

Doctors are privy to — but not really part of — patients' most private moments

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I watched a birth. More than watched: an hour or so after first meeting the mom-to-be as she lay in her bed in a hospital gown, I was helping her push. I was the one who retrieved her glasses so that she could see her new, perfect baby girl. I might be a footnote in some of the stories she and her husband later tell their family about the day their first child entered the world. I’m probably in some of the photos. But it’s almost certain that I will never see those new parents or their daughter again.

My career will be a series of moments like that. Sharing good news, delivering bad, offering a diagnosis or treatment that may change someone else’s life — and then moving on with my own. I will be present at some of the biggest turning points in my patients’ experience, but I will never really be part of their lives.

As a first-year medical student, the imbalance in this relationship becomes even more pronounced. We are nomads by design, migrating through different clinical settings in search of knowledge but rarely sticking around to follow up with patients to learn how things turn out. The intimacy that normally must be cultivated over time is instead granted instantly during the medical interview, by virtue of the training I am now undergoing and of my short white coat. I ask patients to divulge their most closely guarded fears and secrets — When did you first feel the lump? So you’re drinking again? — but I don’t yet have any medical advice to offer them in return.

(MORE: Reality Strikes: A Doctor-in-Training Encounters Her First Patient)

Before too long, of course, I will have expertise to give. Depending on the specialty I choose, I will get to know patients for weeks or months or even decades. But even then, the fundamental paradox of clinical intimacy — so close and yet at the same time so distant — will always be there.

Our teachers remind us frequently how important it is to treat our patients as whole people, to consider their thoughts, feelings, values and experience of illness. And that awareness of the human side is a big piece of what drew me to medicine. Still, there’s no getting around the fact that the doctor-patient relationship and the person-person relationship are just not the same. And maybe the key to honoring the trust patients put in us is to honor that difference. To remember that brief though these encounters are, patients will hold on to them, will look at those photos, over and over again, and remember me for whatever I was for them in that one moment — whether I contributed to a good experience or failed to rise to the occasion. In the person-person relationship, there is room for do-overs. But between doctors and patients, every moment counts.