The Doctor as a "Drug"

Michael Balint, MD was a physician who deeply probed the depths of the doctor patient relationship in his book The Doctor, the Patient, and His Illness. In this book, Balint also discusses two other important concepts that reveal much about the nature of the doctor-patient relationship. The first is the consideration of how the doctor functions as a primary therapeutic agent, much like a "drug", and the other is the concept of the "unformed illness". I'll discuss the "drug" doctor in this post and save the other term for later.

Patients visit doctors seeking relief from some problem, symptom or illness. Apart from surgery, the most common intervention used in the office is prescription of medication. Much like the use of medications, doctors also prescribe a "dose of themselves" when patients need relief. This comes, more than anything else, in the form of active, non-judgmental listening to their patients, encouraging them to talk about what "brought them to the doctor" by asking open-ended questions that put the patient at ease to express whatever is on their mind.

If this sounds more like a description of a psychiatric encounter, that's because Dr. Balint was both a general practitioner and a psychiatrist, and recognized that most illness was a highly complex mix of physical AND psychological factors. By serving as a safe, trusting professional who is genuinely engaged in the patient's problem, the solution starts to become the relationship itself. Patients obtain relief from many of their symptoms, particularly symptoms of "unformed illnesses" that may unknowingly have their roots in deep tensions, insecurities, or anxiety by having a good doctor-patient relationship and, thus, receiving a dose of the "drug doctor" in addition to their antihypertensive or diabetic or antidepressant medication.

Dr. Balint felt strongly that this "drug doctor" could not be effectively used without a highly developed degree of self-awareness on the part of the doctor that allowed them to simultaneously attend to the important medical issues while keeping a listening ear open to the life events and problems that contributed to virtually every patients illness.

Do you obtain a dose of your "drug doctor" when you make an office visit? Your comments are always appreciated...