Who does that doctor think he/she is?
Doctors have spent many years training; following their (5 years) of basic training, in order to practice with a full registration by the General Medical Council in the UK, for instance, they must also have gathered 'pre-registration experience' working under close supervision in medical and surgical specialties for 18 months. After registration many (most) will go on to do further specialist training - for instance as General Practitioners, Surgeons, Psychiatrists, or Physicians. Becoming further registered in one of these specialties requires more exams and more years of training under supervision. So it is important to understand that most doctors will, in one way or another hold a belief that:
"I have earned the right for my opinion to be taken quite seriously"...
At times this can result in doctors being perceived as rather arrogant or belittling of others - and at times this is undoubtedly the experience that patients and other professionals have. MOST doctors would be very unhappy with such an exchange, and would acknowledge and value the richness of of experience that others bring to any exchange. An old saying in medical school is
"Listen to the patient! They are usually telling you the diagnosis!". There is increasing emphasis on communication skills in the medical training.
What do doctors actually DO?
The first thing a doctor will try to do is to make an accurate
diagnosis of the problem the patient is presenting with. This means trying to get an accurate picture of the patient's concerns in their head, and then checking various possible explanations for this concern through examining the patient, or using specialist tests such as X-rays, or blood tests.
Once there is a diagnosis, a doctor will then turn to the scientific evidence and offer the most appropriate
treatment, or refer on to a specialist who can perform that work for the patient.
What are their values?
Aside from the fact that doctors are humans and are subject to as many variations as other members of our race, they are trained in
scientific methods, and this is at the heart of their
ethical stance. This means that they will recommend only those treatments for which they understand that there is valid scientific evidence of
safety and
effectiveness, and they will avoid offering treatments for which there is not yet evidence from trials, or at least from the wider expert community of specialists.
Understanding what a doctor means by "evidence" is helpful.
For a new treatment to be accepted the "gold standard" of evidence is from what is known as a "Randomised Controlled Trial" (or "RCT"). This is when a group of people are gathered together who all have the same
diagnosis. They are then divided randomly (on the toss of a coin, although offten more sophisticated methods are used!) into two groups. The new "trial treatment" is given to one group, and a "placebo" (a substitute that has no active properties at all) is given to the to the other group. In the best trials neither the patients nor the doctors giving the treatment know which group they have been put into (this is known as a "double blind" trial) so that there is less chance of a bias creeping in. This way doctors can tell if when a patient gets betterr it is becuase of a treatment, or just because they would have got better anyway!
Now, in the field of adolescent mental health it is worth knowing that there is (compared to many specialties) a relative
lack of hard evidence, as it is very difficult to set up properly conducted (i.e. not
biased) trials to see if a particular treatment is effective or not.
Doctors can appear dismissive of "new" treatments, or complementary approaches on the grounds that these may not have been subjected to rigorous trials in the way that "their" treatments will have been. At its worst, this can again be perceived as arrogance, or narrow-mindedness. From a doctor's point of view their suspicion of an "alternative" or "unproven" approach may relate to the wish to avoid raising false expectations in a vulnerable person, or spending a lot of money on a treatment that may be no better than "placebo".
Doctors may have different priorities
Doctors tend to have had experience of people dying, and of very serious illnesses. Their first priority is always to exclude life-threatening conditions. This can lead to them appearing rather harsh, or insensitive if they appear relieved that it is "only a fungal infection"... in their mind they may be relieved that "this isn't cancer", whereas the patient may be shocked to feel that her body is being "invaded" in this way.
Doctors are often balancing competing priorities
Most dotors work long hours and have large lists of patients. A common fear for doctors is that in their busy-ness they will miss a crucial piece of information, and will make a mistake. In keeping with their "seniority in terms of training, doctors also often feel (and are treated as) responsible when things go wrong. This anxiety that
"the buck will stop with me" may explain what might at times appear to be an overly cautious attitude.
Doctors (and other healthcare professionals) can be reluctant to discuss a person’s diagnosis or treatment with the carer.There is a real duty of
Confidentiality between the doctor and the patient. If the person is too ill to understand what is going on, doctors
will usually involve the carer in discussions and decisions. From the doctor's point of view it is important to remember that a breach of confidentiality is potentially a very serious breach of the professional code of conduct, which could lead to problems with the General Medical Council and even being stopped from working as a doctor - understanding this dilemma will help a worker or family member to
mentalize the doctor's position; a refusal to share information may not simply indicate that a doctor does not value another worker, or family member, etc.
Doctors tend to be "solution-focussed"
Temperamentally, doctors often tend to prefer to DO things that FIX problems, rather than spend a lot of time in musing and imagining possible explanations or imaginative responses. They may tend to urge people "cut to the chase" in consultations - which can easily leave the people they are talking to feeling rushed, or not listened to. An understanding of the doctor's sense that there may be several other severely unwell patients on his or her books, and the need to allocate the limited time available fairly can help to mitigate this!