After a talk I gave about doctor-patient communication, a woman in her 30s raised her hand and said, "I work at a university, and whenever I see the doctor, he assumes I'm a student, and he talks down to me. This makes me very unhappy and I'm not sure what to do about that." I assumed from her circumstances, and from the tone of her question, that she was not free to choose another doctor. What should be done by someone who has this problem? There are various strategies, but part of the answer is to understand why the doctor might be talking down to someone.
1. The doctor's personality is unsuited to an egalitarian interaction. If they were a chimneysweep there would be the same problem.
2. The doctor was not trained to appreciate the importance of doctor-patient communication.
3. The doctor does not know what to recommend, or recognizes, perhaps subconsciously, that there is no good evidence to prefer one route of treatment over another. This leads to a basic conflict: she wants to help the patient but also acknowledges to herself that there is no one convincing path. Since she has been conditioned to present a front of omniscience to patients, both through the system and the influence of colleagues, she is not allowed to present that ignorance, or to partner with the patient to address it. Thus, she appears abrupt or condescending.
Perhaps I am giving such a doctor too much slack? I would do the same for a patient. Systematic changes mean we should, on occasion, refrain from blaming people without considering the entire differential.