It's never really discussed.
We don't learn it in med school. There are opaque references to it in residency.
Once we're out, it slowly becomes an unpleasant realization. We give it other names, and ascribe the motivation (or lack thereof) to others–our patients.
Patients look to us for medical advice. It's a vulnerable state to be in. A generation ago, we simply told you what to do. And you did it.
Now we practice "shared decision making," and make recommendations to you that you are free to accept or reject.
The conversations are seldom on the level. Most of you don't want to outright defy us. You risk our ... wrath? Our disfavor? Our disappointment (always my parents' strongest weapon).
When you don't follow our recommendations, we call you non-compliant.
The newer, more politically correct term, is non-adherent. Sometimes we just say you're a "bad patient."
But doctors are really (M)ad Men (and of course, increasingly, women). We have to sell you our ideas, even when you've become increasingly knowledgeable and justifiably more critical.
The truth is, selling is easy most of the time: We believe in what we're offering--intellectually and emotionally--and some of our ideas are so commonplace (colon cancer screening, treatment of high blood pressure, etc.) that you are receptive to the ideas. It's a win-win.
It gets a lot harder when we don't necessarily believe in what we have to offer, or are outright skeptical of something that you ask for.
Communication is one of the 'competencies' on which we evaluate trainees. It's vitally important. But we don't teach it or evaluate it well.
Here's a powerful example, appealing to both our minds and hearts, and making the complicated simple and appreciable even by a child.
I wish for better, more straightforward communication amongst all of us.
This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.