The patriarchal doctor and his flaws

The patriarchal doctor and his flaws

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The AIDS epidemic affected significant changes in general practice. Communication and the doctor-patient relationship changed. Instead of giving older people a description of some disease or other, doctors now had to provide increasingly young, often critical people with concrete and clear information about the new virus they had become infected with.

 

A painful communication problem

Personally, as a family physician, I have always disliked vague communication and withholding of information, but I have been confronted with it repeatedly in my career. The psychological strain of “bad news conversations” in the consulting room cannot be underestimated. They are conversations that can weigh heavily on the patient, but also on the physician. Out of self-protection, many doctors avoid such conversations, or make everything seem less serious than it is, so that the patient does not panic. The conversation then supposedly runs easier, but the doctor then becomes the only person capable of making decisions around the treatment method, against the patient’s knowledge. That is a kind of position of power that I will always disapprove of.

 

HIV virus hits vulnerability among doctors

With the spread of the HIV virus, younger, often critical-minded people came into the consulting room. And unlike older people who went to the doctor with ailments, this group could not be appeased with an explanation that made it all seem not so bad. AIDS patients needed a clear explanation of the new disease and its course. And there was the rub: many doctors were not capable of having these conversations. They had always set themselves up as the patriarchal doctor who could decide for themselves what to communicate and what not to communicate … because they had difficulty with the psychological aspect of the consultation, or because they wanted to protect their own emotions. But if a patient does not fully understand what is going on, his chances are simply thrown away. As a doctor, you must take the time to communicate all the information openly and concretely and listen to the patient’s reaction. That way you also know if he understood and if there are additional things you need to assist him in. With clear, concrete language you give the patient all the necessary knowledge and thus also a sense of control. He is then able to make his own decisions regarding treatment and palliative care and the end of life, as was unfortunately necessary with AIDS at the time. At the same time, it also gives him the opportunity to do the things he needs to do in the last months or years of his life.

 

Unprepared to receive first AIDS patients

I was let loose on the population as a young doctor in 1981. I was 25 years old at the time. It was almost impossible to be younger. Suddenly I had to report news of a life-threatening illness to people who sometimes seemed like my spitting image: young, wise, full of zest for life, gay…. It was hard for me too, especially at first. The medical school at the university had always treated this part of the job shabbily. I was not prepared to give this kind of psychological assistance, despite my internship in psychiatry. I did feel helpless at times then, not only because I saw how those people struggled with the disease, but also how they were treated in their families or in the hospitals. For example, I think of situations where the doctor, rather than the patient himself, had determined how the patient would be treated.

 

The situation today

Of course, we have taken many steps in the meantime, but it has taken a long time. Only at the beginning of the 21st century did patient rights change and it became mandatory to allow patients to see their records whenever they wanted. This allowed them to stay informed about their health, see what was going on and yet take more control of their own lives based on that. Yet I’m not going to deny that this paternalistic approach still lurks in health care today, especially in in specialized medicine. I’ll tell more about that in one of our next conversations….

 

Want to read more?

I wrote an article about Hubert*. He contracted AIDS and had to discuss it with his partner.

Link to a webpage on HIV and AIDS communication on the HIV Association website. Consulted on 10/08/2024.

Link to an article that appeared in the 2020 Dutch-Flemish Journal of Palliative Care, on end-of-life communication. Accessed 10/08/2024.

 

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