Respect

Patients should believe that their comments are being listened to, carefully considered, and taken seriously. They must believe that the physician values their comments and opinions before trusting him or her with information of a more personal nature. As long as the physician's attitude toward the patient embodies respect, concern, and kindness and a sincere effort is made to understand the patient's difficulties, the patient will overlook or forgive myriad other problems.

Oliver Wendell Holmes advised patients to "Choose a man who is personally agreeable, for a daily visit from an intelligent, amiable, pleasant, sympathetic person will cost you no more than one from a sloven or a boor, and his presence will do more for you than any prescription the other will order" (1883, p. 391).

A lack of confidence, rather than an excess of it, may lead physicians to appear aloof and unconcerned. Too often, physicians think that a godlike image of omnipotence is necessary for the maintenance of the patient's respect and confidence. It is usually a lack of self-confidence that causes physicians to retreat behind this protective image, which limits their ability to help. Secure physicians are freer to establish close personal relationships with patients without fearing their position will be threatened. A physician with a positive self-image is also willing to recognize and admit the limits of personal competence and feels comfortable seeking help from a colleague when such consultation is of value to the patient's care.

The bond of mutual respect is enhanced if the physician makes positive statements about other people. Patients find it difficult to respect a physician who is regularly detractive, making negative statements about other people or other physicians. Any comments that can be interpreted as "building yourself up by tearing someone else down" merely accomplish the reverse.

The effectiveness of physicians depends on the degree of their insight into the limitations of their personalities and the psychological defenses that distort their perceptions of patients. Physicians must recognize patients or situations that make them unreasonably angry or provoked (e.g., a whining, complaining individual who shows no interest in being rehabilitated, preferring a role of social dependency). The physician's emotions, if they go unrecognized, can serve as a barrier to the development of mutual respect. If the physician is aware of negative feelings toward a patient, an effort can be made to avoid showing signs of irritation or anger. It has been said that clenching of the physician's fist is a clinical sign of a hysterical patient. The physician should attempt to remain objective and analyze the situation for its diagnostic value.

Patients with trivial complaints or somatic manifestations of emotional disease sometimes are given less attention than those with clear-cut organic abnormalities. The frequency with which a physician complains about the triviality and inappropriateness of patients' problems has been found to be related to the volume of patients seen and the degree to which the physician feels overburdened. The more patients that physicians see and the more overloaded their practices, the more likely they are to describe patients' complaints as trivial, inappropriate, or bothersome. Physicians who have more time or take more time per patient, and who investigate the patient's complaints more thoroughly, frequently uncover significant factors and less often tend to view the complaints as trivial. Respect for patients involves taking their fears and apprehensions seriously and withholding value judgments. Patients who frequently seek help for nonspecific somatic and functional complaints may be depressed (Widmer et al., 1980).

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