When like treats like

An illustration by New York Times Service
| credits: New York Times Service

Many years ago I spent a lunch hour in a doctors’ dining room eavesdropping on two white-coated men of a certain age idly discussing a colleague who worked at the city hospital next door.

While they themselves saw mostly insured patients, she worked exclusively among the destitute, a de facto one-woman charitable health organisation.

Most of the hospital community thought she was a saint. These two doctors, to put it mildly, were not impressed.

“It’s easy to do that kind of work,” one concluded, putting down his napkin and standing up.

“The hard thing is taking care of patients who are exactly like you.”

That thought has stayed with me through the years, rearing up at odd moments: when I am fed up with a patient, or a patient is disgusted with me, when one female patient balks at a referral to a male gynecologist and the next specifically requests one.

Just last month, it surfaced when I came across a picture of a smiling vet examining a small white dog.

Sometimes that seems like the only viable place to wield a stethoscope — over a soft, fuzzy nonhuman chest.

Professional training may not remove the interpersonal chemistry that binds us to some and estranges us from others, but it can neutralise these forces somewhat, enough to enable civilized and productive dialogue among all comers.

Yet until the day when we deal only in cells, organs and genes and not their human containers, we will, for better or worse, always see ourselves in some patients, our friends and relatives in others, and our patients will likewise instinctively experience doctor as mother or father, buddy or virtual stranger.

Are the ties that bind us for better, medically, or are they for worse?

Is health care more effective when patient and doctor are the same — the same sex, class, race, tax bracket, sore feet and cholesterol level?

Or does essential objectivity require some differences? When your doctor looks at you and sees a mirrored reflection, is that good for you, or bad?

Anecdotes abound. One woman loves her gynecologist because she “knows just how I feel.”

Another hates the same gynecologist because she “thinks she knows everything.” (The subject of discord was menstrual cramps, the doctor uttering the fatal phrase “They’re just not all that bad.” That was it for the second patient: off to a man whose reactions would presumably be governed by sympathetic imagination, not personal experience.)

Most of the research into imagination versus experience looks at the easiest parameters to measure: sex and race.

In the world of gynecology, a recent article summarising a decade’s worth of polling data concluded that most women preferred female gynecologists (although not because they were united in sisterhood, but because they communicated better).

Another group of researchers found that when patients saw doctors of the same race for a general medical visit, the visits were longer and friendlier and patients were a tiny bit happier.

But when it comes to actual health outcomes, the results are all over the place.

One study found that having a doctor of the same race had no association with good blood pressure control — the important thing was whether the patient trusted the doctor, regardless of either one’s race.

Another found that black patients took their medications a little more assiduously when they were prescribed by a black doctor, but the same did not hold true for Asians and Asian doctors.

Yet another looked at fat doctors and fat patients, finding that diet advice was deemed significantly more trustworthy when dispensed by a larger doctor.

But having a weight-loss coach of the same race did not seem to help patients lose weight.

And those are just the externals. The fallacy that undermines all this research (as well as the reasoning of the two sagacious commentators in the Doctors’ Dining Room), is the assumption that measurable variables define people and their interactions. Impossible to measure, and hence impossible to study, are the real cues – the twitch of a lip or turn of phrase – that tell two humans they are members of the same psychic quasi species.

You walk down a medical office corridor and a low hum of conversation can be heard from all the rooms but one.

From that one come howls of laughter as two happily compatible humans bond over the Mets, the stock market, the difficulty of finding size 10 extra-narrow shoes.

Do these two soul mates also bond over medications, tests, disease management? Or are the medical subjects elided and minimized, lost in the general flow of good feeling?

We know that pairings between like-minded individuals make life worth living and populate the planet. We assume they make health care a more pleasant process. What they do to its outcome, we have no clue.

-New York Times Service.