Physician-Patient Alliance: The Importance of Support
Joel Escobedo, who is earning a medical degree after attaining a Ph.D. in chemical engineering, worked with an FCE patient suffering from type 1 (juvenile onset) diabetes. The disease had been partly responsible for the man’s troubled relationship with members of his family, especially his father. In his adulthood, those early troubles had contributed, in turn, to emotional problems, alcohol abuse, divorce and great difficulty in managing the self-treatment that is essential to a diabetic’s health. As a result, he was frequently in the hospital with hypoglycemia. Joel’s conversations led him to believe that a physician could treat this patient successfully only on the basis of a full understanding of his troubled past.
“From the very beginning, it was obvious that diabetes had almost overtaken his life. The diabetes was all around him, and his wife was in the next circle around the disease, and he was not able to bring the situation to a balance, so that he could say, ‘This is my disease and I deal with it this way, but at the same time I maintain a good relationship so that my wife can be a support to me.’ The way he was brought up, it’s not hard to understand — I don’t think he was taught in his family to rely on somebody.
“So eventually they divorced, and from that point on, everything revolved around diabetes. Every time we met, I learned something new that gave me a sense that this guy was lonely. He had no real friends. He hadn’t been in a relationship because he was afraid that women would be appalled by the [insulin] pump that he uses and the scars from the [insulin] injections. So he avoided relationships as much as he could.
“He said he wanted to join this program [FCE] because he wanted doctors to take a more humanistic approach to type 1 patients. In the past, he had had experiences with physicians who were not very interested in him as a person, but rather were interested in the disease they were trying to control.
“If I were his physician — if I knew that his support system did not exist and that he was as isolated as he is — I would bring on board all the members of the health team: a therapist who could help him learn coping mechanisms to deal with the disease, and to understand better how his upbringing affects how he lives his life; and a pharmacologist so he could have a better understanding of the medicines he’s using. I would think about a social worker for him.
“And I would be less critical. I would manage the interviews with him in such a way that he would see me as an ally rather than as somebody who comes to fix you and criticize you — someone with whom you can negotiate your own fate at your own pace.”
—James Tobin
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