Teflon Doctors and Velcro Patients

I guess I should take it as a compliment when patients come to see me after visiting a specialist and ask me a bunch of difficult specialty-related questions.

“Did you ask the specialist that?” I typically ask, and the the answer will be a plain “no”.

I’ve seen it in action. Some doctors speak quickly, say a lot, and exude so much authority that it’s hard to stop and question them. There is also the fact that on a first visit there isn’t yet much of a doctor patient relationship.

As a long term family doctor, I’m probably viewed as more approachable and less intimidating and therefore end up getting the questions that didn’t get asked in the consultation.

I think a lot about this balance of ours – when and how to engage deeply and with a large “contact area” and when to appear close without engaging or attaching too much. Still remembering when the Teflon frying pan technology, first patented in 1954, took Sweden by storm in the sixties, I use the metaphor “Teflon doctors”.

I consciously move back and forth along this spectrum. In line with my effort to be the kind of doctor my patient needs in a particular situation, I think there are times when I should “stick” and times when I need to be like Teflon.

When a patient hesitates tackling an important issue or feels desperately depressed or disconnected, it is my role to “stick” tight and help them stay with their task or avoid drifting emotionally. But on the other hand, there are times when I don’t let anything stick to me.

The other day when a patient started listing all the minor to moderate aches and pains he’d been saving up for his once a year routine physical, I mentally took a step back and, sensing he was looking for pain medications, said:

“If you have specific pains or orthopedic issues, I or an orthopedist can look into them, but my first duty in a physical is to go over the big health risks you may be facing at your age. Today I will focus on if all your pains are part of a bigger picture, some underlying disease, or if your body just has a lot of wear and tear.”

When patients are suffering in large or small ways, doctors risk feeling like they “own” the patient’s problem. We never do. We are guides, supports, experts and even friends, but we should never shoulder a patient’s problems for them, no matter how much love and empathy we feel for our patients as fellow human beings. Taking over their problem weakens them and creates an unhealthy dependence.

Being “Teflon Doctor” and still helping the patient is an art to cultivate. It involves putting the patient at the center, by saying things like, “how do you feel when…” and “what have you found to be helpful when…”

Sometimes we come across patients who are like Velcro, another product of my childhood, patented in Switzerland in 1955. Perhaps a more common word doctors use for such patients is “sticky”. Fancy talking doctors call them “Frontal lobey“. This is because people with frontal lobe lesions can exhibit symptoms like inability to make decisions and lack of the ability to interact, feel joy and express spontaneity.

One review of the function of the frontal lobe puts it this way:

“The evolution of the human frontal lobes lies at the very essence of the characteristic behavior of humans. Everyday traits that define our existence, both socially and as individuals, have important substrates in the frontal lobes: humor, intuition and insight, deception and truthfulness, optimism and skepticism, affection and hatred, and inspiration. One of the great tragedies for patients and their families is a disease of the frontal lobes that destroys the distinctive personality around which a whole life has been built.”

All doctors have known patients who have difficulty moving forward or away from a minute topic or medical history item, who keep coming back to a thought, often kept on a list of concerns, and who seem unable to grasp a bigger picture.

What I tend to do in order to move forward with patients like that is to “chunk it down”. I try to create smaller steps, descriptions, decisions and interventions. But it is hard work and it almost always takes more than fifteen minutes.

Unless you’re a better Teflon Doc than I am…

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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