by Scott Haig, MD

The blind， overweight patient in the wheelchair has terrible pain in her back and burning pain in her legs. She also has advanced 1）arthritis in her knees and 2）end-stage circulatory disease， which have left her with two useless legs that are red， 3）swollen and infected. Now her shoulder has started to hurt. She cant raise her arm to comb her hair. Five or six other things are wrong with her—she tells me about each. Some we can help； most we cant. I tell her as much. In my office， she listens carefully. I hardly ever have to repeat myself with Doris. She also asks some questions—mostly good ones. She needs lots of tests， various therapies. I ultimately recommend an operation on her shoulder. Sick， weakened by multiple symptoms and with 4）lousy insurance， Doris is—surprise—a really good patient. She communicates efficiently with her doctors and treats us with respect and trust. She has reasonable expectations.

I can tell she looks things up， but her knowledge is helpful—never challenging. Ive talked about her with other doctors， and we agree on this： when you see Doris name on your days list， you know youre going to work hard. But youre usually glad her name is there.

Few patients realize how deeply they can affect their doctors. That is a big secret in medicine—doctors hate to admit. Actually， We think about， talk about， dream about our patients. We went into clinical medicine because we like dealing on a personal， even 5）intimate level with people who have chosen to put their bodies in our hands. Our patients make or break our days. Take the compliment. Our career choice means we really do think that you—with your aches and pains—are more interesting than trading hot securities， more fun than a courtroom full of lawyers. Massaging the ego is the key to manipulating responsible types like doctors. When we feel your trust， you have us.

The most compelling reasons to be a good patient are selfish ones. You will get more than free drug samples if your doctor is comfortable and communicates easily with you. Youll get more of the mind that you came for， a mind working better because its relaxed—recalling and associating freely， more receptive to small， even subliminal clues. That means better medical care. But you should try to be a good patient for unselfish reasons too. We worry about you 60 hours a week. We gave up our 20s for you. Why not show us some love？ Its not hard. The medical relationship is 6）intrinsically one-sided. Its about you and your problem. I am going to find out more about you in the next 20 minutes than you will find out about me. Dont fret about that. We dont expect you to ask much about us. Good patients answer questions accurately and completely. Of course， they ask questions too. But many patients talk too much. You might notice that we are writing when we see you—we are creating your chart. We need specific facts but not every fact in your life.

Heres a classic exchange：

“How long has your shoulder hurt， Beatrice？” “Oh， for quite some time now.”“But for how long？ How many months？” “Oh， at least since the wedding—well， then again it did act up a bit when Margaret came back from Ireland…”

All I want to do is write something like“Right shoulder， 6 months， no trauma” on my chart. Although I lack the heart to tell her， Beatrice would be a better patient if she tried to be a bit more concise. However， there are lots of Beatrices.

Heres another classic：

“Well， I dont need to have good manners—Im sick—and Im not going to be a 7）patsy for some 8）smooth talker in a white coat. 9）The squeaky wheel gets the grease， you know.”

That is the 10）mind-set of many patients who abuse their doctors； my bet is they abuse other people as well. Any good doctor knows when youre too sick to be polite and will let it roll off his back. The squeaky wheel we dont like is the one playing a dominance game. That big wheel is likely to get a shorter， less sensitive examination and more tests， and then still more tests to follow up on the abnormalities in the first tests， followed by extra consultations with specialists—anything to relieve the doctors responsibility for a bad patient.

Are doctors good patients？ Others may disagree， but I think they are. Medical 11）jargon doesnt 12）faze them， so communication is easier， and their expectations tend to be more reasonable. Anyone in medicine is painfully aware that there are plenty of problems for which we have no good answer. Nurses tend to be even better patients， being 13）adept at following doctors orders—a virtue lacking in doctors. Doctors and nurses also know when to respect an educated opinion. When the 14）MRI says one thing and I want to do another， they are more likely to be on my side. But you need not be a medical profession， or educated at all， to be a great patient. Its pretty much the same strain of human 15）decency—a truthful consideration of the people around you and of what they are trying to do—that infects a good patient and any good person.

那個雙目失明、超重的病患坐在輪椅上，她的背部和雙腿承受著可怕的、火燎般的疼痛。另外她的膝蓋還患有晚期關(guān)節(jié)炎，而晚期的循環(huán)系統(tǒng)疾病也讓她已喪失功能的雙腿又紅又腫，且感染發(fā)炎。目前她的肩膀也開始疼痛得抬不起手臂來梳頭。她還患有其它五六種疾病——她一一告訴了我。有些我們幫得了，但對于大部分我們無能為力。我把這些都如實告訴了她。在我的辦公室里，多麗絲仔細(xì)地聽著。說一遍她就懂了。她也會問我一些問題——多半都是些好問題。她需要接受大量的檢測，各種不同的療法。最終，我建議對她的肩膀進行一次手術(shù)?？v使多麗絲帶著病態(tài)，也因多重的癥狀和差勁兒的保險變得越來越虛弱，但她——令人驚奇的是——的確是一個很棒的病患。她與醫(yī)師們進行有效的溝通，并給予我們尊重和信任。她對自身的病情有著合理的期待。

看得出來她會自己去查一些資料，但是是為了有助于療治，而不是給醫(yī)生制造難題。我曾與其他醫(yī)師談起過她，我們一致認(rèn)為：當(dāng)你在自己的日程表上看到多麗絲的名字時，你就知道你要好好工作了。但你通常會因為看到她的名字在那里而感到愉快。

很少有患者意識到他們能夠如此深刻地影響自己的醫(yī)師。在醫(yī)學(xué)上，這是個大秘密——醫(yī)師們是不樂意承認(rèn)的。其實，我們會經(jīng)常想到自己的患者，談?wù)撍麄?，夢到他們。我們之所以從事臨床醫(yī)學(xué)，是因為我們愿意與那些選擇將生命交諸于我們手上的人打交道，甚至是建立親密關(guān)系。我們的日子成也患者，敗也患者。請盡情贊賞吧。我們的職業(yè)選擇意味著我們確實認(rèn)為你——連同你的疼痛與不適一起——比火爆的證券交易和律師滿席的法庭審判要有趣得多。鼓勵是籠絡(luò)有責(zé)任感的人群的關(guān)鍵，比如醫(yī)師們。當(dāng)我們感覺到你的信任，你也就贏得我們的信任。

成為一名優(yōu)秀病患的最具說服力的理由還挺自私的。如果你與醫(yī)師的相處使他感到舒服，并且能與你輕松溝通，你就能夠拿到更多的免費藥物樣品。你會從醫(yī)師那兒得到你渴望得到的診治判斷，因為在他感到輕松時才能更好地工作——自如地回顧、總結(jié)你的病情，并抓住那些細(xì)微的、甚至小到無法察覺的細(xì)節(jié)。這意味著你將得到更好的醫(yī)療服務(wù)。但你也應(yīng)該試著為一些無私的理由去當(dāng)一個好病患。我們每周為你們的病情焦心60小時。為了你們，我們放棄了自己的弱冠年華。為什么不給我們一點愛呢？這并非難事啊。醫(yī)療關(guān)系本質(zhì)上是種單邊關(guān)系，一切都圍繞著你以及你的病情。在接下來就診的20分鐘里，我將了解你更多，這遠比你對我的了解要多得多。不要著急，我們也不希望你問太多關(guān)于我們的問題。優(yōu)秀的病患能夠精確和完整地回答醫(yī)生的問題。當(dāng)然，他們也會問一些問題。但是，很多患者講得太多了。你可能留意到了，當(dāng)我們與你見面的時候，我們一直在寫著什么——我們在創(chuàng)建你的病歷。我們需要具體的事實，但不是你生活中的每一個細(xì)節(jié)。

這兒就有一段經(jīng)典的醫(yī)患對話：

“你的肩膀痛了多久了，比阿特麗斯？”“哦，痛了很長一段時間了。”“但，很長是多久？有幾個月呢？”“哦，起碼從婚禮那時就開始了——對，瑪格麗特從愛爾蘭回來的時候，又痛了一陣子……”

我無非是想在病歷上寫一些比如“右肩，疼痛6個月，無外傷史”之類的東西。但是我卻沒有勇氣告訴比阿特麗斯，如果她能試著陳述得更簡潔些，她將是一個更優(yōu)質(zhì)的病患。遺憾的是，有太多像比阿特麗斯這樣的病患了。

這兒還有另外一個經(jīng)典的例子：

“好吧，我不需要有禮貌——我病了——我才不會輕易上你們這些舌燦蓮花的白大褂兒的當(dāng)呢。會哭的孩子有奶吃，你知道的。”

這是很多折磨醫(yī)師的病患們所持有的思維定勢；我打包票，他們也如此折磨他人。任何優(yōu)秀的醫(yī)師都明白病患病情過重?zé)o法自控而導(dǎo)致失禮的狀況，醫(yī)師們也會照單全收。我們不喜歡的是那種唯我獨尊的“哭鬧病孩”。那樣的“大架子病患”得到的可能是更為簡短、粗略的檢查和更多的測試，緊跟著是針對在第一輪測試之后發(fā)現(xiàn)的身體異常，再做更多的測試，再然后是一些不必要的專家會診——任何能夠讓醫(yī)師減輕對一個麻煩病患的醫(yī)療責(zé)任的方法。

醫(yī)師們會是優(yōu)質(zhì)病患嗎？其他人可能不同意，但我認(rèn)為他們是。醫(yī)學(xué)術(shù)語難不倒他們，所以他們與醫(yī)師之間更易于溝通，并且他們的期望也往往更合情理。學(xué)醫(yī)之人都痛苦地曉得醫(yī)學(xué)上有太多令我們束手無策的難題。當(dāng)護士成為病患時，往往會做得更好，因為她們善于遵循醫(yī)囑——而醫(yī)師們?nèi)狈@種品質(zhì)。醫(yī)師和護士也知道何時應(yīng)當(dāng)尊重一個專業(yè)人士的觀點。當(dāng)核磁共振報出一個結(jié)果，而我卻不茍同時，他們有可能會更贊同我的觀點。但要成為一個優(yōu)秀的病患，你根本不需要成為一個醫(yī)學(xué)專家，或去接受醫(yī)學(xué)教育。與人類優(yōu)秀品質(zhì)的傳承如出一轍——真誠地為周遭之人設(shè)想并為其將要嘗試之事表以關(guān)心——這些便造就了一個優(yōu)質(zhì)病患和所有好人。