Psychologically Speaking, There are Two Types of Doctors and Two Types of Patients
Circumstances make us distinguish between things and make us distinguish between them in different ways. Obviously, there are many types of doctors and many types of patients, but I think it may be useful for some doctors and some patients to distinguish between two types of each.
2 types of doctors
It may not have always been this way, but applicants to medical schools in the United States are not chosen, on the whole, by the schools for the originality and independence of their thinking. To get through medical school it is necessary to have the ability to absorb a tremendous amount of information. Neuroanatomy, anatomy, histology and all the other subjects have been accumulation grounds for facts that have been piling up for hundreds of years now. Every one of these facts is, or could be, critical for a future doctor to know. If a student were to ponder on the individual facts, question the thinking that led to their being assessed as true, wonder what the facts mean or what underlies them, and so on, the student would not get past the first few pages of the the thousands of dollars worth of text books they are required to buy and learn and, to a large extent, memorize.
Seen in this light, thinking is a liability for a student in medical school. Medical school is not a graduate program in philosophy.
When it comes to beginning to interface with patients, there is probably more emphasis given to creativity. But, even here, the fact that scientific medicine has come so far that there is a firm body of knowledge with respect to diagnosis and treatment for so many diseases, the requirements for learning how to diagnose and treat are less and less open-mindedness, creative inspiration, and deep pondering, and more and more the ability to recognize and register relevant facts and plug them into a computer-like "a-b-c = d" part of the mind. In fact, I think it is fair to say that the ideal and goal of scientific medicine is to be able to plug symptoms into computers and to wait for the computer to come up with diagnosis and treatment. This is the ideal of the insurance company but also of the profession itself.
Certainly there are many cases that resist this approach and where old-fashioned intuition is useful, but, I think, on the whole, there are few who reach the place in their training where these cases become their full responsibilities who have been encouraged, at any point in their training, to think for themselves. Most of those who were able to retain their natural curiosity and desire to follow hints and clues to their ultimate ends had either dropped out of medical school or were on the road to a carrier in medical research.
So the first type of doctor is the one who has never seriously questioned the individual facts presented for him or her to absorb let alone the whole body of medical knowledge. What's there in the text books and the medical journals and in the pharmaceutical brochures are true. If they turn out not to be true, that is not a problem that shakes them to their intellectual foundations. Rather it is seen as "the way science works." Science is a gradual process based on statistics. There is never an hundred percent certainty about any scientific fact. It is always possible for new research to overturn old "knowledge." The fact that this type of doctor believes, one hundred percent, in the old "knowledge" and bases their diagnoses and prescriptions on them does not give them any cause for anxiety. They do not worry that what they are taking now as their knowledge, may, in a few years, turn out to be looked back on as their ignorance. In the extreme case, the fact that their patients may die from their treatments does not make them pause and wonder — even if certain patients might fight back and argue and feel uncomfortable with some treatment or other. They are practicing the most up-to-date medicine, and, whatever the outcomes, they will be supported by their colleagues, by their ethical boards, and by the courts of law as having used methods that are in accord with the current standard of care and as told to them in their continuing education courses and in the articles appearing in the latest practice journals.
It may be that, one day, all doctors will be computers, that is, that there will no longer be human doctors. Just as computer guided missles seem to be less fallible than humans, computers may turn out to be more reliable than humans with regard to doctoring. Maybe or maybe not. But the point is, that this seems to be the ideal and goal of one type of doctor — to become more computer-like, to turn more and more responsibility for their decisions over to the body of knowledge stored in a computer (or the computer part of their own brains) and to have it processed the way computers process material stored in them.
But we have not reached that point, and so there is a second type of doctor. This is the doctor who realizes the imprecision of the medical method, its unreliability and instability, its vulnerability to error, and its inherent danger. It may be that this doctor was always humble in this way, more careful, less naive. Or it may be that his or her own medical experience led to this attitude. Perhaps the doctor made a mistake that led to a death. Perhaps the doctor had seen so many cases that did not fit neatly into the models generated in his or her training, that it was no longer possible for the doctor to trust the models or to trust him or her self.
For this type of doctor, a patient's intuition and thoughts are relevant. In some cases, even in many cases, it will be thought that there are many ways to skin a cat. There are many subtle factors that can influence cures, both for the good and for the bad.
Further, this second type of doctor will have become accutely aware that medicine is a business, that hospitals are organizations where political and economic factors lead to doctors supporting each other and covering for each other's mistakes. It is not an ideal world in which doctors praise each other for their genuine accomplishments. (Of course, on the negative side, a type two doctor may be a malcontent who tried to fit into the medical establishment and failed and who is now bitter and envious and harbors a grude — a dangerous type of person indeed. We will leave this type of person aside, but, as patients, we must be aware they exist.)
Type 2 doctors will be aware that researchers are employees and have, as we all do, economic motives (not to mention professional pride) mixed in with their desire to find the truth. And the companies that employ them may prefer to hire company men rather than brilliant geniuses and may not be beyond using tried and true sales methods to influence doctors in order to peddle their studies and their products.
The over-all situation leads to the bewildering question, Who to believe and when? Who can be trusted? Even one's own motives are suspect, at least at times. "Alone and afraid in a world I never made," is the feeling here. Yet there is a need to jump in and decide and act and the appearance of indecision can, itself, at times, influence the health of a patient in a negative way.
This second doctor may be or may become a deep thinker, a genuine thinker, whereas the first doctor is more a "Yes" doctor, a carbon copy, a dishonest thinker. Yet there will be many times were the first doctor, just because he or she is following the herd, will have the better answer, whereas the second doctor, who is trusting him or her self a bit more, will go off some edge or other, sometimes even into grandiosity. Intuition and deep thoughts have moments of brilliant success and moments of supreme failure.
We all are aware of the two types of personalities in all fields, but it easier, I think, to forget that there are these two types in the field of medicine also. It is easier to forget, because we need doctors so much, or, at least, we need them so much when we need them. We are so vulnerable at these moments of need that we may slip into a child-like attitude where they seem almost like all-knowing gods. And they can enjoy this image and even begin to believe it themselves. If they get mad at us and criticize our own thoughts and feelings and intuitions, we may, almost instinctually, assume we are wrong, and the tension of the conflict in ourselves between thinking we are right and thinking we are wrong can, itself, affect our illness.
2 types of patients
This line of thinking leads to the idea that there are two types of patients, just as there are two types of doctors. And these two types of patients are parallel to the two types of doctors.
On the one hand, there are patients who assume their doctor is an expert, like an expert auto-mechanic or an expert computer technician. When the car breaks down or the computer stops working, we take it to the appropriate technician to be fixed. Our bodies are like cars and computers. When our bodies break down, we take them to a medical doctor to be fixed. We know as little about the workings of our bodies as most of us know about the workings of our cars or our computers. We have to trust the technician to be good at what he or she does.
Our friend tells us such and such a doctor is "good," or we see he (or she) went to a "good" school went to, or we look at what hospital he (or she) works at or at how many years he (or she) has been in practice or, maybe, how many articles he or she has written or whether or not he or she is head of a hospital department and so on. If the doctor passes some inner credentialing process, we relax and trust. This is especially true if the doctor has a pleasant smile and a pleasant personality, and if we and everyone else likes him (or her).
As this first type of patient, we will follow the doctor to the end of the treatment rainbow (as it were), as if we are following a trusted captain into battle. Any doubts we might have, we attribute to our own ignorance or lack of faith, and we may not even express our thoughts or doubts, because we don't trust ourselves in this area, and because we don't want to appear "difficult" to our leader and get the doctor angry at us.
Of course, it is obvious looking at the situation from this angle, that we might be stupid to trust in this way. The doctor may be wrong and may be pig-headed or limited or not very bright or unwilling or may lack self confidence or be naive or arrogantly ignorant. We may be right, and this leads to a discussion of the second kind of patient. The second kind of patient trusts him or her self more than the first kind of patient and trusts the doctor less, especially the first type of doctor.
How someone becomes a second type of patient (or person) may be from different paths. Some people may be born suspicious of authority, for good or bad. Or a person may have been burned so many times by doctors or other authorities that he or she does not trust anymore. This can be a problem in some situations and a strength in others.
Perhaps the second type of a person is a deep thinker, not so much a rebel or a recluse or a mistrusting person or a cynic, but someone who sees how things work and has a realistic, though open-minded, scepticism. When this type of patient meets the first type of doctor there is a genuine conflict. The patient wants to ask questions, to get more information, but the doctor, of course, is impatient and irritated and will blame the patient. The patient may begin to doubt him or her self and wind up being brow-beaten into submission. And maybe, oddly enough, this will turn out for the best, if the doctor, after-all, is correct.
On the other hand, the patient may actually be right. The doctor may be caught up in some medical fad. Or the doctor may be so busy seeing patients, so pressured to accumulate billable hours, that he or she willfully overlooks the subtleties of the situation, the little factors that mean some test or technique or treatment is really not as good as he (or she) says it is (to the patient and to his or her colleagues and to his or her self). This may be intellectually dishonest if, deep down, the doctor, realizes that, a year from now, he or she may very well be seeing everything differently. But the doctor will not want to dwell on such ideas.
The first type of doctor may never have studied the research behind the treatments he or she is recommending. If the type two patient asks about the research, the doctor is likely to get defensive, and the relation may spiral downward. The patient may quickly come to know more than the doctor about the research studies. The irony is that, in spite of any reprehensible aspects of the doctor's behavior and attitude, the doctor may, in fact, be right. If the patient reacts to the negative qualities of the doctor's personality and to the lack of true, personal knowledge (instead of a kind of herd knowledge), it might be the patient who is hurt, because the doctor may be right, even for the wrong reasons.
If the patient gets angry and, rightfully, seeks another doctor and succeeds in finding a type two doctor who has a deep sense of the nature of medical knowledge, there is no guarantee that this "wonderful" doctor will be right; this doctor may very well be wrong.
Similarly, for a Type 1 patient who was accidentally matched with a Type 2 doctor. The Type 1 patient is looking for a confident doctor, a doctor who doesn't show signs of thinking too much, of indecision. If this patient picks up doubt in the doctor, especially if there is any sign the doctor is struggling and may even be tortured in his or her role as expert, the patient may misread this as incompetence and ignorance and abandon the one doctor who can see deeply enough to penetrate, albeit hesitatingly, to the true cause and cure of the disease.
There is, I think, no easy way to choose a doctor. To choose a Type 1 doctor is not so much to choose the doctor but to choose the whole current body of medical science and practice. To choose a Type 2 doctor is to chose, in addition to whatever knowledge and competence the doctor has achieved, the clinical skills of this particular man or woman. (And, of course, it is an over-simplification to think that every doctor is either a Type 1 or a Type 2 type of doctor. Almost all doctors will have both features.)
I think both types of doctors can offer something. Whether we are a Type 1 or a Type 2 patient with respect to some particular illness, the goal is to find a cure, not to find a great doctor, whatever we think is a great doctor. But, I think, there is no way to insure, in each of our individual cases and situations, the right way to look for and find cures. Perhaps it is best to find a doctor who combines the best of both types or, probably more realistically, it may be good to have a few doctors from each category with whom one feels free to consult. I should add that not all Type 1 doctors are defensive. Some are quite nice and friendly and, hopefully, modest. And doctors should remember that they can learn from their "difficult" patients and that these are often the patients who affect them deeply and who they remember years later.
The goal of this article is not to suggest the right way to choose a doctor, but simply to talk about different types of doctors and patients and possible interactions between them to help make the whole relationship between doctor and patient a little more conscious, on the part of both.