I got a call from a co-intern last night, practically in tears. A patient yelled at her. She was giving the patient his test results-- he has a medium-serious condition, but not something that's going to kill him-- and was trying to offer sympathy by telling the patient about her mother, who has the same condition, and has lived with it for years and it's been okay. And apparently she got a little emotional talking about her mother, she let down her professional guard for a second-- and the patient got annoyed, said he didn't care about her or her mother, said he wasn't her therapist, he wasn't even her friend, and he wants a different doctor who can be more professional about it. (So she called in the senior resident, who took over dealing with the patient....)
It's weird-- it's such an imbalanced relationship we have with patients. We know all sorts of things about them. We know about their most personal issues, often we know secrets, or at least things they're not eager to shout from the rooftops. And yet they know very little about us, and it's "unprofessional" if we even make the attempt to form a more even bond. We heard a presentation a few weeks ago from an OB/GYN who's been dealing with her own fertility struggles for the better part of the last decade-- her talk was about the difficulty of keeping her personal life separate from the patients, of being able to be as enthusiastic about her patients' successes in this area of her life where she's had so much pain and difficulty.
In our careers, she said, we'll know some of our patients for years-- we'll know multiple generations of families, we'll experience the highs and lows in our patients' lives. And yet it's very rare that we'll be able to (or that it would be professional to) share as much from our end as we're supposed to take from our patients. The danger, she warned, is that it's easy to think our patients are our friends, especially since we know so much about them. But they aren't, or at least they shouldn't be.
I think this is a sad and frustrating point of view to have about the medical profession. I think we can be doctors as well as friends; I think we can be doctors as well as people, and that letting our patients know us doesn't have to be a bad thing. Even from the perspective of improving patient health, I expect that patients who feel closer to their doctors are willing to reveal more, and sometimes reveal things that would lead us closer to the right diagnosis, that they may not even know are relevant. Patients don't always know what the right things to tell us are, symptoms they don't even see as symptoms might be exactly what we need to know. And, besides, it seems a lot more rewarding for us as doctors if we feel like in our offices we can be people too, and not hide our humanity.
Then again, I see what the OB/GYN meant. I went to the dentist yesterday-- taking care of so many exciting things over my vacation-- and as she was looking at my x-rays, she said I shouldn't worry about an occasional cavity. "I'm a dentist," she said, "and even I get cavities. People look at my teeth and tell me how nice they are, but they don't see the back-- I have fillings all over the place. And my mother was a dentist! But it didn't matter. I still had terrible teeth growing up. I still do. I'll tell you a secret-- I don't always floss. I try, but I forget all the time."
This was too much. I just met the woman. I don't want to know all this. I don't know that I want to go to a dentist who doesn't floss.
Although, I'll tell you-- last night, I flossed twice. Just to be safe. So maybe it worked. If that was all a strategy. Which it probably wasn't.