Breaking the Doctor-Patient Relationship

The last couple of years have presented some troubling developments when it comes to the fragile relationship between physicians and patients, one that requires a high degree of trust and confidence on both sides in order to be effective. A patient who does not feel comfortable with a doctor may not disclose the truth, may elide symptoms or not answer questions fully, may not bring up ‘secondary’ issues that are actually important. Such patients in turn are labeled as difficult and noncompliant and may be subjected to browbeating and other tactics to get them to speak up, which only makes them more hostile and less inclined to trust members of the medical profession, setting off a vicious loop.

One of the key components of the doctor-patient relationship is the knowledge that both sides are being totally open and honest, providing all available information about the situation, and speaking accurately and truthfully. This may be limited by the knowledge of both parties; a doctor discussing test results cannot disclose results of a test that has not been performed, for example. Likewise, a patient may not report a symptom because the patient doesn’t view it as a problem, doesn’t know it’s relevant to a diagnosis, or isn’t sure how to talk about it.

In a situation where a patient doesn’t know if a doctor can, or will, tell the whole truth, the dynamic of trust evaporates. Patients are forced to view their medical providers with suspicion because they have good reason to. Their doctors are not reliable sources of information who will be truthful, nonbiased, and informative with lots of information about treatment and diagnosis options. They are not allies working with the patient on a specific medical condition to address the situation. Instead, they are more skin to enemies whom patients need to go through or around to get the care they need—or at least, this is how patients can feel when navigating such relationships.

Several US states have passed laws effectively allowing doctors to lie about prenatal diagnoses. Under such laws, patients are in a terribly awkward position with care providers, because they don’t know if the information they are being given is trustworthy. The doctor may be reporting 100% accurately and appropriately, making sure the patient is apprised of all necessary information, or not. This creates an oppositional relationship with patients, particularly when they have no choice but to see a given doctor, and have no opportunities for seeking out alternatives and additional information.

The doctor-patient relationship here is broken, which means the expecting patient may not report problems related to the pregnancy, and complications could develop. Or the patient might not have the information needed to prepare, making birth traumatic and potentially dangerous. Or stress about the unknowns of the pregnancy and the relationship could overload a patient, who might develop complications because of it; high blood pressure associated with stress, for example, can be dangerous for the developing fetus. In the haste to limit the right to choose in the United States, legislators in these states have directly impacted maternal and fetal health in a negative way; the fetuses they are so bent on protecting are actually endangered by their efforts.

Other states have issued limitations on what doctors can talk about, which means they treat patients with their hands tied. In Pennsylvania, for example, doctors can’t provide information about the ingredients of fracking chemicals when they treat patients, which means that patients do not know what they were exposed to. This makes it hard for them to research and make educated choices, and it could cause problems in the future. If patients develop complications related to the exposure and their charts are redacted, incomplete, or not available, they won’t be able to help out care providers with a detailed medical history. All they have to go on is the limited information they were given at the time of the initial exposure.

Many doctors are opposed to these kinds of medical gag laws, arguing that they interfere with the practice of medicine, endanger patients, and limit free speech rights for physicians, who should be able to communicate safely and effectively with patients about medical issues. When you can’t be told which chemicals are in your own body, and what the risks of those chemicals might be, and how they might behave in the long term, you can be in serious danger. And you are deprived of autonomy and the ability to make choices for yourself; you are reduced to having the doctor recommend a course of treatment and make vague comments about potential symptoms and side effects, because the doctor risks legal repercussions for being open.

Like ag gag laws, medical gag laws are revolting, and they’re also growing in reach. Every time a law passes without challenge, it gives legislators courage to pass more laws and extend their reach to other regions. Old laws serve as models for new ones as neighbouring states pick up the use of gag laws as well. Court cases become more and more difficult to assemble as the reach and strength of the laws tightens, and judges become reluctant to reverse the trend; there’s always a more expensive attorney on the other side of the courtroom arguing that the law is necessary to protect patents, or reputation, or some other interest of a company, and that attorney will argue until the other side runs out of money.

Attacking gag laws requires first knowing about them, and by their very nature, they remain secretive and hidden. People who don’t closely follow  legislatures and trade magazines may not be aware of what is going on around them—which means they may not be aware that people like doctors are not necessarily figures to be trusted and relied upon, because they may have restrictions on their speech, or conversely may be allowed to be selective about information sharing if they think a patient might be considering a pregnancy termination.

Unfortunately, discussions about gag laws often attract minimal attention, when these conversations should be shouted from the rooftops. This is important, and it shouldn’t be swallowed up by other news items.