Monday, March 16, 2015

The Intimacy Gap

I used to think that there was a communication gulf between doctors and patients.  Somewhere in the hub-bub of of the harried office visit some secret sauce was missing.  A divide that was so fundamental that both parties often left the room feeling disjointed and uneasy.  Patients wondered if doctors truly heard them.  Physicians wondered if any one was listening to what they were saying.  The tension ebbed and flowed but never disappeared.  This has been the state of health care over the last decade.  This has been the environment in which I have built my clinical career.

I now believe that the term "communication" is imperfect and lacks the specificity that I am looking for.  I think what we truly have is an intimacy gap.  What separates doctors and patients is a disjointed and unnatural version of intimacy that in no way mirrors the important bonds that we form in real life non-medical relationships.

Let me explain.

A patient walks into the exam room and unloads the most intimate, embarrassing, and frightening secrets to their doctor.  Unlike close friends or loved ones, the physician has in no way earned this privilege.  They had not gained this right through hours of conversation, years of support, or acts of selflessness.  There is no shared struggle or trust.  It is given too freely.

The doctor listens patiently and kindheartedly.  But the interaction can only be so rewarding.  There is no mutual disclosure of secrets.  No bidirectional sharing of intimacy.  The physician remains stone faced, objectively detached.  This is what we learned in training.

The practitioner, conversely, is bombarded day in and day out with urgent and emergent situations.  There often is no normal period to engage and form stronger bonds.  They are shuttled from exam room to exam room trying to put out fires without any of the nicety of experiencing their patients during non turbulent times.

When disaster hits, physicians become immersed in someone else's pain and tragedy.  But when they die, or get better, or move away, we are plucked out of their lives and rarely are present for any sense of closure.  By then we have moved on to the next case, the next emergency.

Disjointed, unnatural intimacy.

I don't know how to solve this problem.

For my part, I have decided the only solution is to strive for mutual disclosure.  Maybe we, as physicians, can tell our stories.

We can tell our stories to those we care for,

so that they may also care for us.

My Book: I Am Your Doctor And This Is My Humble Opinion



Anonymous said...

You know, that's one powerful and interesting truth. Just by getting an advanced degree and training, doesn't mean you've earned that right. I've seen that right abused enough to know that. I will say that those who have been honest with me and treated me like a human being with decency and respect, I go out of my way for.

Anonymous said...

This is woven into why I long to be a NP, am studying toward that. I believe, how health care is changing this relationship is hard to make time for, to build and sustain. As a NP, I do not want to replace physicians. I want to serve in ways within NP knowledge, experience with patients that need a NP, needs can be met by a NP. I want to have collegial relationships with other NP's and physicians - as what we are trained. As a nure, a RN with a BSN, having gone to college to get a BSN, worked as floor nurse in med/surg, OB/GYN, taught at a diploma school, worked in long term care, home health, now school nursing in psych schools, I long to use skills and compassion in ways the limits put upon me in systems make nursing skills smaller than they are.