Do Patients Really Know What Physicians Do?

JUNE 13, 2018
Thomas Castles
As I pored over my Twitter feed last week, I was struck by the number of physicians piggybacking off each other’s “What do you do?” tweets. At first, I chuckled. Then, I got pensive. I realized that these tweets might be spotlighting a perturbing question:

Do people really know what physicians do?
It may seem ridiculous at first, but think of it like this: For most people, physicians are the first humans encountered upon exiting the womb. Physicians are not only present during many people’s births, but also their deaths, and many of the profound moments of sorrow or joy in between.

An injury? An infection? An accident? An addiction? Weight lost? Weight gained? Birth given? Birth taken? A quick recovery? A slow descent?

A physician will be there to guide you.

But still, these tweets are a repository of anecdotal evidence suggesting that many people are unsure of what doctors do, which is by my estimate a clear reflection of poor health literacy. If it is a health literacy question, then anecdotal evidence in the tweets is supported by the literature – just take a look at this health literacy data map from the University of North Carolina at Chapel Hill, which estimates that 22% of the US population has only basic health literacy, and 14% have health literacy that’s below basic.

There’s no indication that the algorithm the authors used to make these estimates included questions about patient understanding of what physicians do as a factor of health literacy, but can we really expect patients to understand the difference between a pediatric palliative care specialist, an internist, and an obstetrician if their health literacy is so poor they can’t identify the information they need to stay adherent to their insulin?

As Howard Koh, MD, MPH and Rima Rudd, ScD, MSPH wrote in a 2015 editorial, “It’s a troubling paradox. In the midst of rapid expansion of medical knowledge intended to benefit many, too few actually understand medical information well enough to improve their health.”

We can take this a step further. Not only do many patients lack knowledge about what physicians do, they also hold misconceptions about what it means to be a physician. Many believe that doctors are inherently wealthy, perfect decision makers with enviable lifestyles. The truth is, despite their above average salaries, many doctors are in boatloads of debt. Despite their years and years of training, they often make mistakes. And despite the fact that they could live luxurious lifestyles, many physicians hardly feel like there’s a world outside of the hospital or clinic, and are feeling increasingly burned out and suicidal.  

What if there was greater awareness of the supreme effort needed just to get through medical school and internships? What if more people were cognizant of the integrity, fortitude and stamina necessary to handle the everyday hardships of being, say, a trauma surgeon or palliative care specialist? What if we could tally all the pandemics that infectious disease specialists and epidemiologists have prevented?

If we could, then physicians might be lining up alongside police, firefighters and military service members during the next national anthem, because without doctors, the world would be a much different, much more dangerous place.
  Editor’s note: This is a column written by Tom Castles, associate director of editorial. His analysis reflects his views, not necessarily those of the magazine.

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