DOWD: Decoding the doctor-patient relationship

Medical schools are starting to train doctors to be less intimidating to patients. And patients are starting to train themselves to be less intimidated by doctors.

We haven't completely gotten away from the syndrome so perfectly described by Alec Baldwin's arrogant surgeon in the movie "Malice": "When someone goes into that chapel and they fall on their knees and they pray to God that their wife doesn't miscarry or that their daughter doesn't bleed to death or that their mother doesn't suffer acute neural trauma from postoperative shock, who do you think they're praying to? .

.

. You ask me if I have a God complex. Let me tell you something: I am God." But there have been baby steps away from the Omniscient Doctor. The federal Agency for Healthcare Research and Quality has begun a new campaign to encourage patients to ask more pertinent questions and to prod doctors to elicit more relevant answers."I used to think, &‘He's a doctor. Who am I to ask a question?'

But there have been baby steps away from the Omniscient Doctor. The federal Agency for Healthcare Research and Quality has begun a new campaign to encourage patients to ask more pertinent questions and to prod doctors to elicit more relevant answers.

"I used to think, &‘He's a doctor. Who am I to ask a question?'

" Bill Lee, a Baltimore man who has suffered 10 heart attacks, says in a video on the agency's website urging people to speak up. Patients have more options, a flood of Internet information and a bombardment of drug ads listing side effects — and that can be terrifying. It adds to the general anxiety level that health insurance costs are rising sharply and that President Barack Obama's health care law seems headed toward the Supreme Court.The "experts" are always issuing guidelines, which are soon contradicted by another set of "experts." It happened with the recommended age for regular mammograms, and it's happening with guidelines on hormone replacement for postmenopausal women.First, estrogen was going to be the fountain of youth. Then hormone replacement therapy was going to spell doom, causing heart disease, stroke and breast cancer. And now, as the Wall Street Journal reported Tuesday, "some experts are reaching a more nuanced view of the risks and benefits and concluding that hormone therapy may still be a good option for healthy women in their 50s, depending on their symptoms, family history and worst fears."Each patient, a Michigan gynecologist told the Journal, is like a Rubik's Cube, and must get an individual solution.That is also the message of a new book, "Your Medical Mind: How to Decide What Is Right for You," by Jerome Groopman, an oncologist, and his wife, Pamela Hartzband, an endocrinologist, both members of the Harvard faculty and staff physicians at Beth Israel Deaconess Medical Center in Boston.Few people have done as much to demystify medicine as Groopman, who has written four other books and lots of New Yorker essays aiming to help doctors understand that patients are often neglected allies with good intuition, and to help patients get confidence and control by understanding how doctors think. Like a Middle East peace broker, he aims to lower the stress level and bring together two sides who perpetually misunderstand each other.With his white beard, 6-foot-5 stature and friendly manner, the Queens native certainly looks trustworthy. Stephen Colbert once accused Groopman of "trying to look like God."And I can say from personal experience — since I've known him, he's provided guidance that helped save the lives of three members of my family — that he is a fierce, sensitive and generous patient advocate. (And an aficionado of Irish literature.) Hartzband and Groopman warn against excessive reliance on overreaching so-called experts and nebulous metrics and statistics."The answer often lies not with the experts but within you," they write, adding that the Albert Einstein line is apt: "Not everything that can be counted counts, and not everything that counts can be counted."The authors stress that "the best" and "informed" can be subjective terms, and that your prognosis can often look very different if you "flip the frame" of reference. They try to decode the Orwellian language that prevents physicians and patients from cooperating, and show how doctors can project their own preferences on patients.They interview patients who are Doubters and Minimalists, who may agree with Voltaire's view that "the art of medicine consists in amusing the patient while nature cures the disease." And they interview Believers and Maximalists, who go for radical treatments too quickly.They confess that they have a mixed marriage: Hartzband tends to be a Doubter (her mom's mantra was "Doctors don't know everything") while Groopman tends to be a Believer (a status that got shaken when he jumped into a spinal fusion operation that had "disastrous consequences"). "The unsettling reality," they write, "is that much of medicine still exists in a gray zone, where there is no black or white answer about when to treat or how to treat."But they are both optimists who warn against the "focusing illusion" — focusing on what will be lost after a colostomy, mastectomy, prostate surgery or other major procedures. "The focusing illusion," they write, "neglects our extraordinary capacity to adapt, to enjoy life with less than &‘perfect' health."