For those stuck in the old rut, doctors and patients alike, the doctor is an authority figure not to be questioned, something like a god donned in a white overcoat. Such a god makes pronouncements. He neither explains nor gives any reasons for his actions. He merely orders everyone around, especially the patient. Therefore, the old style doctor/patient interaction is set-up like a one-way street; the doctor does all the talking and the patient does all the listening. According to the same understanding the doctor’s role is that of ‘the fixer’. The doctor fixes your body like the expert mechanic fixes your car – while you yourself don’t have a clue as to what is being done, and why. However, in medicine, the ‘fix-it’ approach only works well, in emergency room situations when every moment counts, as an acute problem has to be addressed immediately. In long-term and preventive health care, on the other hand, the same ‘fix-it’ approach will always miserably fail because it notoriously fails to address the underlying root causes of any given chronic problem. In an emergency situation popping a pill or receiving an injection may save lives. In chronic cases it often only makes matters worse by compounding the original problem, depending on the duration of the treatment with sometimes a long list of additional side effects – which then likewise need ‘fixing’, i.e. medicating.
This is precisely why modern educated patients opt for a different route. They follow the adage that, “An ounce of prevention is worth more than a pound of care.”
Although at present still in the minority, the modern educated patient cherishes health to the point that he or she is not interested in merely managing his or her diseases. Even when merely unwell, out of the loop and lacking energy, educated patients want to know and understand what is wrong with them. They are already somewhat in the know; they have looked up stuff on the Internet and want the doctor to provide more and especially, more solid background information. These are smart patients who quiz the doctor when they come for a first consultation. They require, even demand explanations. After which they want to be presented with options as to what can actually be done, and with the reasons why. This is the type of patients that mostly come and see me, and when we start to work together on their health issues we are entering into an equal partnership.
One other factor needs to be taken into account. Once people have reached a certain level of understanding of their own bodies and their bodies’ interaction with the mind, they will automatically desire more from medical treatment than just being made barely okay again. They will aim higher, graduate from coping. They want to be highly functional and at the same time feel good in their skin. They want to enjoy every moment of life.
The change of goal from ‘being made okay again’ to being supported in the means for achieving vibrant health and aliveness, in turn, automatically changes the role of the physician from being a ‘fixer of diseases’ to that of being a health coach. For the informed patient, the role of the doctor is to point out the way, and to explain one or several different courses of action to the clearly defined end of feeling vibrant, and totally alive. Thus the doctor/patient interaction ceases to be the traditional one-way street, but changes into an information highway instead, with lots of traffic back and forth both ways.
This change is inevitable. Many are presently discovering through the failure of medicating low-level or even highly troublesome chronic complaints that vibrant health cannot be achieved through the old ‘fix-it’ approach with the physician in complete control of the patient’s treatment. For vibrant health to manifest, the patient has to be fully involved and, to begin with partially and later fully in charge of his or her own healthy choices in terms of lifestyle, diet, exercise and so forth. This does not make the physician obsolete, far from it. The physician’s presence is still very much required in his or her capacity as expert support: to help the process along, to give advice and act as sounding board for client-feedback.
According to my experience this change from being the ‘fixer’ of the disease to becoming a partner in health makes the doctor’s life infinitely more interesting. I do not enjoy telling people what to do. I much more enjoy discussing with them what can be done, and why.
Although in certain situations and when it is absolutely necessary, any doctor is prepared to take command. Which goes to show that both approaches are helpful, depending on the situation. In emergencies, the doctor has to be exercise authority; in chronic cases he becomes the health coach – but both in the spirit of equal partnership. When the physician then gives advice, it is based on both test results and the input from the patient.