About patients and doctors.

Disease and illness are terms that are usually in the minds of both the public and the medical profession. Disease refers to a pathophysiological process translated in findings derived from history, physical examination and laboratory investigations and ends with a definite clinical diagnosis. Hence, it is a physician's set of cognitions. Illness on the other hand, refers to patient's experience from the disease. This is reflected in four dimensions including feelings, ideas, functions and expectations. The problem stems from the fact that the physician and patient are on different tracts of thought. Consequently, doctor-patient relationship is unfruitful when this confusion is ignored. If physicians stick to tackling patients’ problems from their standpoint of disease (doctor-centered approach), they tend to miss the submerged part of the iceberg of the patients’ problems. In particular, patients’ ideas arising from culture and traditions include health-related misconceptions. These comprise a significant component of problems that are related to patient compliance with treatment and follow up. In Middle-eastern societies, numerous health-related misconceptions prevail. For example, in the Kingdom of Saudi Arabia, there are sixty documented misconceptions about diabetes mellitus.1 Diabetes mellitus management now rests more on patient education; and if they remain unexplored and uncorrected by physicians, these misconceptions will no doubt form a strong barrier against adequate disease management. It should be mandatory for practicing physicians to acquaint themselves with patients’ health-related misconceptions. But that cannot be achieved without the ability to maintain good doctor-patient relationship.

Indeed, doctor-patient relationship remains a fundamental issue in patient care. In addition to the building of this relationship, physicians need to be trained on doctor-patient communication skills. These skills used to be viewed as inherited talents. Now, however, communication skills are acquired by training. They are included in undergraduate curricula,2 and taught to practicing physicians through workshops and other means.3 Only physicians who are equipped with communication skills are able to explore the ‘illness’ process in their patients and include it in their management of ‘disease’ process they clinically diagnose. Medical education programs must now address this issue that has evolved as one of the cornerstones of good health care.