Hillerson 1

Natalie Hillerson
Dr. Krisjon Olson
Anthropology 215 AA
19 May 2014
Examination of the Doctor-Patient Relationship Through the Merging of These Two Roles
Introduction
The relationship between doctors and their patients is perhaps one of the most important
relationships in societies throughout history. Historically, patients have put huge amounts of trust
in their doctors and caretakers by yielding to examination, which is often invasive in both the
physical and emotional sense of the term. However, the relationship between doctor and patient
is becoming increasingly more strained as the American healthcare system essentially pits one
against the other, usually in favor of the doctor. As Nancy Scheper-Hughes implies in her article
Three Propositions for a Critically Applied Medical Anthropology, the negotiations patients
and doctors make while trying to find the best route of care are actually more like manipulations,
with the doctor winning (190). Even the language of negotiations implies a purely businesscentered relationship instead of a caring one, making it clear that the doctor-patient relationship
is under duress and almost adversarial at points. With such a separation between patients and
their doctors, what happens when these two roles are merged? In this illness narrative, I examine
the growing disjoint between doctors and patients as told through one doctors experiences being
both a patient and a physician. I also explore the ways in which having direct experience with
being a patient positively influences the way one practices as a doctor by instilling a humanistic,
or patient-centered, approach, thereby improving the doctor-patient relationship.

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Methodology
The interview was conducted on April 17th, 2014 in the afternoon. The interview subject
was my 29-year-old brother, Dustin Hillerson, M.D., who was a week away from completing his
fourth and final year of medical school at the University of New Mexico at the time of the
interview. We talked over FaceTime and I recorded the discussion on my phone, which was out
of sight. I gave Dr. Hillerson a copy of the interview questions I prepared before conducting the
interview so he would be familiar with what we would be talking about and be able to begin to
formulate responses. The interview lasted around one hour.

Patient as Doctor, Doctor as Patient

A patients perspective is essential for proper treatment, as empathy greatly helps the
doctor understand the patients woes and therefore can assist doctors in treating their patients
more effectively. Albeit unfortunate, the most effective way for doctors to gain this insight into
the plights of patients is, quite simply, through being a patient. Of course, this insight does not
solely come from being a patient, but in listening effectively and truly caring about the patient,
and not just the injuries and how to fix them. I should note that I am in no way suggesting
doctors injure themselves only to experience first-hand being a patient, but I hope that the
insights Dr. Hillerson gained will illustrate the need for improved listening while interacting with
patients and encourage physicians to spend more time gaining a narrative and approaching
medicine exclusively through a humanistic lens.
On June 29th, 2011, before starting his third year of medical school and therefore before
any direct contact with patients, Dr. Hillerson was in a motorcycle accident and spent about a
week in the hospital: in the Intensive Care Unit (ICU) for a couple days, and then the larger

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hospital for another five days. Outside of the hospital, he spent several months recovering on his
owngetting back into shape and dealing with the repercussions of his broken bones and
concussion, among other wounds. Because of the extent of his injuries, Dr. Hillerson had
multiple doctors spanning many fields, but no central physician, which he described as
frustrating, because all these people who are focused on one problem, like a broken jaw, or a
broken neck, were only focused on that issue, and [he] didnt think anybody really looked at the
big picture (Personal Communication, 2014). This specialization, while arguably helping the
patient receive the most knowledgeable care from a highly trained doctor, also serves to confuse
and isolate the patient from his own healingthere is no stability or constant figure in the
treatment process to anchor the patients emotional state in this time of trauma. A humanistic
approach would be highly beneficial in this instance, providing patients with knowledge about
their illness and assuaging their worries and confusion through this relationship-centered
practice.
Just as Dr. Hillerson was confused throughout his healing process, his family was as well.
He describes one instance where a doctor came in and announced that Dr. Hillerson was going to
be moved to the operating room for surgery, which came as a complete surprise to his family
visiting him, as recounted here:
My mom had no idea what I was getting surgery for, or that it was happening. She didnt
talk to the surgeon who was going to do it, no one had filled her in and the nurse didnt
really know, which I think is devastating as far as the system is concerned.
The family didnt even know the extent of Dr. Hillersons condition or what he required
to be in good health once more. Again, lack of communication and explanation with both
patients and their families is what leads to an unpleasant hospital experience and an unsatisfying,

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bordering on resentful, view of doctors and the healthcare system. Keeping families aware of the
patients situation is crucial, as families often play a large role in emotional healingbeing
supportive in a mental capacity and helping in a physical capacity. Dr. Hillerson describes his
mothers role in the weeks and months after his discharge from the hospital:
[She] did amazing things, I mean, she moved me back to her house and blended every
meal for me, since my jaw was wired shut, and drove me around cause I couldnt
drive I was in a position where I couldnt have managed, I couldnt have done what I
needed to do alone. And she took care of it. I didnt need to worry about her not being
there.
As Arthur Kleinman suggests in his extensive book, Patients and Healers in the Context
of Culture, [d]isease affects single individuals but illness most often affects others as well
(73). This idea implies that families too are affected by the patients disease (in this case, an
accident) through the concept of illness, and they are put through an emotional strain as well. By
this reasoning, doctors should keep the family as involved and as informed as possible in the
patients healing process in order to assuage this emotional anxiety and give them the tools they
need to effectively address the patients health issues outside of the hospital.
One of the most surprising and disconcerting insights gained from the interview was Dr.
Hillersons assertion that the majority of the care he received was a direct result of him knowing
the medical system, and thus knowing who to talk to in order to get certain treatments in an
expedited and efficient fashion. This medical nepotism, so to speak, came in during Dr.
Hillersons healing after he was cognizant enough to realize he wasnt healing the way he should:
[W]hen I realized that neurologically, psychologically, I wasnt getting better, and I
would ask for help people would put in a referral but nothing would go anywhere, it

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would just kind of get lost. So I was grateful that I was a part of the school and got in
touch with somebody who knew somebody who could get me in soon and arranged
everything for me and followed up that way. If I didnt have that foot in the door, I am
completely confident that nothing would have happened, that I would have just been lost
in the system, and wouldnt have had the follow up that I needed.
Dr. Hillerson is unique in this waypatients in his position but without this advantage
would have been completely lost and despondent, unable to have the self-sufficiency to take
charge of their own health and feel in control of their body again after spending grueling time not
knowing what was going on. And even with the extra know-how Dr. Hillerson had regarding the
ins and outs of the hospital, he was still dissatisfied with his time there. This further emphasizes
the failings of the healthcare system, even to someone who is as involved in it as Dr. Hillerson.
Being a trauma patient heavily influenced Dr. Hillersons life, especially the way he treats
patients. While in the hospital, he felt like he was merely a problem to solve, and because of this,
Dr. Hillerson takes a humanistic approach to medicinenever forgetting that patients are
humans going through a difficult time and need not only physical help, but emotional support as
well. Dr. Hillerson states that he makes sure that he sees the big picture and always lets the
patient know whats going on, information that was lacking to him during his own experiences as
a patient. This approach would have never formed without direct experience in the patients
shoesbeing a patient made Dr. Hillerson a better doctor. He knows the importance of the
doctor-patient relationship and strives to make it as strong, productive, and trusting as possible.
In the next section, I discuss Dr. Hillersons experiences as a doctor using the humanistic
approach, and how using this approach can begin to repair the doctor-patient relationship.

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A Young Doctor
As Dr. Hillerson began to interact with patients and play a direct role in their healing, he
developed a particular way to greet them and make them feel comfortable in his presence. When
first meeting with a patient, Dr. Hillersons approach to greeting the patient is outlined here:
I always shake their hand and make an introduction I acknowledge and introduce
myself to the other people in the room, which is usually family. I try to sit down, so Im
not talking down to them. I try to get to know a little about them, let them know that I
realize theyre a person, and not just a problem that has to be dealt with.
This approach is reminiscent of A Fortunate Man: The Story of a Country Doctor, in
which John Berger and Jean Mohr describe the life of Dr. John Sassall and his relationship with
his patients. This relationship, much like the relationship Dr. Hillerson is trying to establish, is
defined by a much more patient-centered approach to medicine: getting to know the patients and
treating them like humans instead of objects to be tinkered with and subsequently fixed. It is
these qualities that led Berger to describe Dr. Sassall as a good doctor, a good listener, easy
to talk to, and understanding (62-63). These qualities similarly resonate with Dr. Hillerson.
After greeting the patient, Dr. Hillerson then goes about planning a course of treatment by first
obtaining a narrative, asking a very broad question like what brought you here today? until
sufficient knowledge is gathered about the patients situation. However, this is not the only
approach a doctor can take when dealing with patients. Dr. Hillerson claims that he has come in
contact with doctors who forget that theyre talking to a human being and just want to deal with
the problem. When asked how this affects the way they interact with patients, he stated that
he believes:

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patients put a lot of faith in physicians it takes a lot of time, and a lot of energy, and a
lot of vulnerability to go to someone with a problem and ask for help, and some
physicians look at that as an opportunity to obtain dominance
Doctors matching Dr. Hillersons description are sprinkled throughout hospitals around
the country, and they contribute to the growing adversarial relationship between doctors and their
patients. Ivan Illichs critique on healthcare in his book, Medical Nemesis, explains this well:
health care has become a commodity, something one pays for rather than something one does.
Healthcare has veered away from a deeply internalized structure of beingsomething one
does with passion and purpose, and instead is turning into a marketplace for treatment,
considering the value of human life as a negotiable good.
This unfeeling definition is at the core of the budding antagonistic relationship between
doctors and patients, and is introduced through the case of the hospitals in McAllen, Texas
home of one of the most expensive health-care markets in the country according to Dr. Atul
Gawande in his 2009 article, The Cost Conundrum, featured in The New Yorker. The article
goes into great depth about the intricacies of McAllens hospital system and how the
astronomical costs of healthcare at these hospitals does not necessarily correlate to care of
exceptional quality. In fact, a lot of the cost stems from doctors running a plethora of tests to
diagnose a patient in order to cover their bases, protecting themselves from malpractice suits
something the doctors in McAllen readily admitted to. This overuse of medical care indirectly
causes a rift between the patients and their doctorsthe doctors dont want to be sued for failing
to diagnose someone, so they rack up costs through countless procedures to ensure that theres no
way the patient can claim something more could have been done. This entire process degrades

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the trust that patients have in their doctors ability to make sound and thoughtful decisions
regarding their health, and to a certain extent, their wallet.
However, taking a humanistic approach to medicine can help steer modern healthcare
back into the right direction. Through the interview process, Dr. Hillerson shared several
anecdotes in which the doctor-patient relationship was put under direct duress or conflictand
while not quite as extreme as a malpractice suit, they still are indicators of the growing lack of
faith between doctors and their patients. Within these anecdotes lie solutions to fixing the doctorpatient relationship, and Dr. Hillerson serves as an example of one solution by way of his
humanistic standpoint. The first anecdote is a very simple, very abundant one. Dr. Hillerson
describes what he calls a classic example of differing expectations of doctors and patients:
[S]omeone comes in with a cough, or some sort of upper respiratory illness, and wants
antibiotics but when its just a virus, which it most commonly is, there isnt an antiviral
treatment, and antibiotics can actually have an adverse effect so we try to minimize our
use of antibiotics. And a lot of patients get pissed when they dont get antibiotics,
because if its viral all we can say is, Fluids and rest and cough drops and control the
symptoms theres nothing we can do to really cure this, so theyre like Well, why did
I even come to the doctor if youre not going to do anything for me?
He went on to describe a recent survey documenting how a substantial amount of
physicians would prescribe an antibiotic to a patient who had a viral infection, just so their
patients would be satisfied, which in turn contributed to the reimbursement from Medicare the
doctors receive. This example further proves that the doctor-patient relationship is becoming
strained, as doctors only look at patients as a way to improve their ratings and increase their

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income, and ignore what is best for themgoing so far as to administer a medication that causes
more harm to the patients in the long run, such as in the example of antibiotics.
This sequence of events is encapsulated by Illichs idea of clinical and social iatrogenesis
unintentional harm that stems from seeking medical care, affecting both the physical health of
patients and the way society views medicine as the primary way to deal with sickness. This case
is both an example of clinical iatrogenesis, as a patients health worsens as a result of doctors
orders, and social iatrogenesis, because people come into the doctors office expecting a quick
cure and they ignore their bodys natural healing response as a treatment itself. However, these
iatrogenic effects can be avoided. When asked whether or not he would administer an antibiotic
to a patient with a viral infection simply because they wanted it, Dr. Hillerson responded, I feel
comfortable and confident that I would refuse prescribing antibiotics because I know its not the
right thing to do. His unwavering response to misinformed patients reflects his humanistic
approach to medicinehe puts the patients health first, explaining to them the reasoning behind
their medical issue instead of giving them useless and harmful medication that will in turn give
him a larger Medicare reimbursement.
The last anecdote Dr. Hillerson relayed was one that was particularly eye opening to him
because the patient refused live-saving treatment because of her religious beliefs. In this
instance, the patient was bleeding in her stomach, and she needed a transfusion to make up for
the huge loss of blood. However, she refused to get a blood transfusion because it went against
her beliefs as a Jehovahs Witness. The different doctors involved in her healing had varying
ranges of responsessome were more understanding of her reasoning, while others tried to be
blunt, telling her she would die if she didnt get the transfusion, though she remained firm in her
refusal. In a situation like this, reminiscent of the James Bay Cree society in Ronald Niezens

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Healing and Conversion: Medical Evangelism in James Bay Cree Society, no amount of medical
jargon will convince a patient out of her convictions and a different, more humanistic approach
needs to be taken in order to fully understand the patients situation. In the Cree society,
traditional ways of healing were drowned out as modern medicine came into the James Bay
resulting in a discrepancy in the care that was received, as the Cree people were uncomfortable
in the modern hospitals. Some doctors, as Dr. Hillerson pointed out, do not understand the
traditional, sometimes religious, basis for patients misgivings. This lack of understanding leads
to a lack of proper care and a strained relationship if no lengths are taken to correct this. A
humanistic approach, taking into account all factors of a patients situation, medical and cultural
alike, can help bridge the gap between patients and doctors, and make for a more holistic
treatment plan that is amenable to both physicians and patients.
It is evident that the lack of understanding and communication is at the heart of the
strained doctor-patient relationship, and if this is not mended, the relationship is doomed to fall
apart completely. As seen through Dr. Hillersons testimony, a humanistic approach is key in
healing the doctor-patient relationship. His experiences as a patient first sparked his drive
towards this approach, but all doctors can and should put their patients stories first, listening to
narratives and treating their patients with carein both the medical and emotional sense. This
broadened approach to medicine has the ability to reinstate the trust between patients and their
doctors that has been deteriorating over the past decades and bring hope to the future of modern
American healthcare.

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Works Cited

Berger, John, and Jean Mohr. A Fortunate Man. New York: Pantheon, 1981. Print.

Gawande, Atul. "The Cost Conundrum." The New Yorker. 1 June 2009. Web. 19 May 2014.

Illich, Ivan. Medical Nemesis: The Expropriation of Health. New York: Pantheon, 1976. Print.

Kleinman, Arthur. Patients and Healers in the Context of Culture: An Exploration of the
Borderland between Anthropology, Medicine, and Psychiatry. Berkeley: U of California,
1980. Print.

Niezen, Ronald. "Healing and Conversion: Medical Evangelism in James Bay Cree
Society." Ethnohistory 44.3 (1997): 463-91. Web.

Scheper-Hughes, Nancy. "Three Propositions for a Critically Applied Medical

Anthropology." Social Science & Medicine 30.2 (1990): 189-97. Web.