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Doctors often come across as abrasive, arrogant, rude, unsympathetic, uncaring, and detached. Why?

"Life is a helluva thing to happen to a person" is insightful dialogue from a past episode of Criminal Minds. One of the cast was explaining to another how a 'normal' person subjected to extreme pressure can be deformed into a gargoyle. As I dissect into the lives of people, the more I have come to see this as less fiction and more of a fact. We are creatures of circumstance, doctors without exception.

Some fields of medicine are naturally more optimistic than others. Obstetrics for example pairs you with couples in one of their most celebrated periods of life—the birth of a baby. General surgery tends to promote closed conversations: your gallbladder has stones, ergo it needs to come out, now here’s the date of the surgery, end of conversation. But family practice and psychiatry can be emotionally bloody and conversationally taxing. I often feel like a priest at confessional as I sit and listen to stories of infidelity, incest, rape, financial hardships, home invasions, addictions, attacks, abuse, ad nauseum - on top of the other aches and pains of everyday life that populate a family doctor’s day planner.

Doctors over time may acquire a form of traumatic stress disorder as their memories become sedimented with a cesspool of unpleasant accounts and confessions. Many of the sordid stories I have been told I can never forget, and the horrors I have witnessed I will never be free of. We also have to keep dirty secrets that gnaw at our entrails. The husbands and wives in for sexually transmissible disease screening after an indiscretion that “just happened”. Or the family at risk of fission with one partner none the wiser. People like to watch disasters and murders vicariously on television but recoil when they see these things in the high definition of real life. Likewise, the juicy gossip that sells rags and talk shows ratings is rancid rancour to the ears of doctors.
The hard, grumpy exterior that some doctors project I believe to be a defence mechanism like growing a lapideous thick skin to protect yourself from needles. Having met many of the notoriously gruff ones out of their lab coats over alcoholic beverages, I can say that they can be disarmingly convivial. So the next time your doctor appears gruff or grumpy, imagine them as a naked thick-skinned Rhino as they pontificate. When they ask why you’re laughing, tell them to read this article.

Why does my Doctor look Bored when I talk?

Of the hundreds of thousands of clinic conversations I've had, I remember one patient telling me that his doctor always seemed to be bored by what he was telling him; physically there but mentally in orbit. What I explained to this nice gentleman, is what I'll now tell you. We see the same things over and over, day in and day out. While a new symptom will be exciting to you, it's hackneyed to us. And the older a doctor gets, the older each story gets. I wonder if this is why senior citizens aren't big movie consumers; I see them at malls, but rarely at cinemas: I guess there's only so many permutations of the 'path of the hero' story line you can see without losing interest.

The gentleman I was speaking with had a flare up of gout in his big toe. And he was so excited. He wanted to share with me how it felt worse than his past kidney stone, how he could not even bear to let his bed sheets brush across his toe, how he wished I could just amputate it. What he could not comprehend is that every patient with podagra (big toe gout is so common it even has it's own moniker) relates the same story. Yawn.

It takes a lot to ruffle the feathers of a physician. If you want to get our attention, don't rely on your narrative. Maybe wear three hats, dress like Elvis, or speak in falsetto like the Bee Gees. That will get anyone's attention, even a doctor's.

Why won’t my Doctor let me get a word in edgewise?

Very often talking to doctors can seem like we all have coffee induced ADHD. There are two main reasons for this. The first, is time constraints; we need you to get to the point. The second is that we often need very specific information to come to a conclusion and much of the information people volunteer is unhelpful verbal diarrhea (logorrhea). Sir William Osler (he's to medicine, what Einstein was to Physics), used to say that doctors should listen carefully to their patients. I think that was before we only got ten minutes to do so.

Why is my Doctor so arrogant?

Some doctors can give the impression that they were born with a stethoscope dangling from their neck; their tone, their posture, and their manner screams at you: "I'M THE DOCTOR, HOW DARE YOU QUESTION ME?" But behind this Freudian facade, I believe there's a scared little doctor hiding. I recall squirming when I first entered into practice and feeling undermined, uncomfortable and overwhelmed when confronted with the prototypical 100-question-patient. It still irritates me today when patients focus in excruciating detail on symptom explanations at the expense of concentrating on solutions. Feigned arrogance, and paternalism, are defence mechanisms that many doctors employ to protect their sensitive insides and get the visit to conclude.

If we seem arrogant to you, it is probably not because we know soooo much more than you, but because there is so much more that we don't know. And that's what spooks us into defensive postures.

As a final note, remember that doctors are human too. We often aren't fully aware of the face we put forward while stressed. Over the years many of my longstanding patients have reported to me that in unfavorable encounters with other doctors that providing them with feedback led to an amicable conclusion to their visit. People view rotten 'bedside manner' as evidence their doctor is heartless. It is not. Doctors are often physically tired, or psychologically tired of hearing the same things over and over. A patient with a new lump gets all excited and wants to shout it from rooftops and sing about it on social media, but a doctor has seen that, and just about anything else you can muster, many times before. It is difficult to pretend to be excited. And let's not forget the emotional erosion that comes from the long repetitive hours most doctors work. The same people that complain about doctors being monotonic, monosyllabic, monochromatic, morons, if placed under the same pressures would turn into doppelgangers sporting just as bad a hair day and attitude to match.

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