What do you think is the physician-view of an “ideal patient”?

Well, as physicians, though we would like to think of caring for an ideal patient, we have to face the reality that this would rarely happen. You see, the ideal patient would be one who, first of all, bears many of the views and goals of the physician. As physicians, we really can’t believe that we will be so lucky. Then, physicians generally yearn for illnesses which they can easily diagnose and readily treat to an outcome which is optimal for the patient.

That usually means that the patient has real physical symptoms, one acute disease — not confusing multiple new diseases at the same time and, finally, clear cut physical findings and lab tests. The illness, hopefully, would have standard treatment which is virtually universally satisfactory and the risks of treatment being minimal, if at all.

The patient should be alert, in good spirits (not too sick), have confidence in the physician, readily competent to make decisions, thoroughly interested in learning about the illness and its treatment and willing to take time to listen carefully to the explanation by the physician and the options of further diagnostic tests and treatment. And when it comes to treatment, the ideal patient will make the effort to follow the physician’s prescription directions and remain fully compliant. The patient will also carefully monitor their reaction to the medication and promptly report to the physician any side-effects or complications. The ideal patient will also have the ideal family. Such a family will support the patient but also show confidence in the physician and support the physician.

As I mentioned at the outset of this posting, this all may be just wishful thinking on the part of the physician. It is unlikely that all these features would appear in the one patient. However, if the doctor had repeatedly such ideal patients, caring for them might be a boring experience. The wonderful “goose-bump” experience of a physician suddenly finding that he/she has made an emotional/spiritual connection with a patient would no longer occur. The wonderful challenge of the difficult diagnosis and the emotional uplifting for the physician who has made the diagnosis that was missed by others, even specialists, would be missing. The splendid realization of a cure, finally occurring after a course of many ups and downs, would be a rarity if all cures occurred easily and on schedule. Finally, if the physician had all ideal patients, the challenge of the difficult patient, the difficult family and the challenge of managing the patient and family if the cure doesn’t come will be absent.

It is the job of a physician to make the diagnosis when the illness is not easily identified, to make the patient’s treatment satisfactory when that isn’t easy or simple and finally to meet the criteria and be that ideal doctor to every patient who turns out not to be the ideal patient imagined by the physician.

Maurice Bernstein is an internal medicine physician who blogs at Bioethics Discussion Blog.