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Chemophobia, Family Medicine, and the Doctor-Patient Relationship

Some things change with the times; some things remain the same. Patients still hurt, healers still try to diagnose, treat, and prevent illness. Symptoms and signs of illness still come in rational, scientifically understandable syndromes and patterns. These can be lab-tested, clinically confirmed with agreed-upon treatment plans, and peer-reviewed by medical professionals. Skilled doctors can communicate to their patients the most likely outcomes of healing or chronicity, with caring and compassion. Some things change in medical practice, especially with new diagnostic methods, including MRI technology, and enhanced serology and biopsy information. Pharmaceuticals are increasingly potent, diseasespecific, and capable of dramatic cures as well as serious deleterious side-effects. What is unchanging in medical practice? It is the doctor-patient relationship, so eloquently defined in the 1960s by Dr. Michael Balint, in a classic called, “The Doctor, His Patient, and The Illness.”1,2 Unchanging is the need for a fundamental level of trust between patient and doctor which begins with the first encounter at the bedside or in the clinic. The relationship may continue over time, through the ups and downs of the course of acute and chronic illnesses, until either the patient or the doctor dies. Continued trust requires continued observation, nurtured by caring, competence, and commitment on the part of the healer and his staff. Differential diagnosis by the clinician requires a delicate balance between defining the “organic” (pathophysiologic) basis of symptoms and recognizing the “functional” (subjective, stress-related) basis of the patient’s very real symptoms. In the past, continuity of care in the smaller community of rural practice was a given. Over the years, the cumulative wisdom of the general practitioner became legendary and revered by generations of grateful