Saturday, January 26, 2013

Day 224 - why do you ask?

I have always found the question of how much of myself to reveal to patients to be a thorny one. My initial feeling was that I should not reveal anything of myself because the encounter is not really about me, but then my patients taught me differently. When I started in Exeter, I picked up a practice intact from a doctor who was moving out of state. Fortunately for everyone involved, my style and hers were fairly similar and patients were not too shocked by my ways. One thing that surprised me, however, was that fairly frequently patients would tell me stories about her or her son, that she preferred salty snacks, that she had problems with sinusitis or similar sorts of things. None of the stories were inappropriate at all, but they always seemed surprising to me. At that point, I would never tell people personal things about myself at all and, yet, I could see that people really valued the stories they had about her. I wondered if I would be a better doctor if I told occasional stories about myself. I started letting out little pieces of myself if someone asked if I had children or if I liked the snow instead of dodging the question I'd answer in a straight forward way. It didn't seem to weaken the relationship so I kept doing it. I experimented a couple of times with offering information along the lines of "I can be sympathetic with how terrible sinusitis is because I get it all the time too" and I never seemed to be able to get it in a way that felt authentic and useful so I stopped.
I changed jobs and my patient population changed somewhat to include a large group of young women who had just graduated from their pediatricians. A number of them were facing big issues: college, moving away from home, first job, terrible boss, sexuality issues, mean co-workers, all the things that one faces as an adult that one may not have faced as an adolescent. Their issues and personalities filled the room and I returned to being as plain as a piece of tin foil.
About this time, I started talking with my therapist about the doctor-patient relationship and the idea of being a blank slate about whom patients can imagine whatever is most therapeutic for them made a lot of sense. I returned to letting very little information out. As the years went by, I began to share more and more about myself with some patients--those who did not seem to have needed me to be a reflecting surface. It was never the focus of our conversation, but I have shared the story about "holding thumbs" from the Community Hospice House many times, can be sympathetic about children leaving home in a way that works and I have travel photos I've taken and a couple of very high quality oil paintings done by family and friends on the walls of my exam rooms. I will tell people who painted them if they ask.
Now, I've had leukemia and it is generally known. I wonder what impact that will have on what I tell people about myself. Currently, it is not something I disclose to patients although I think it's about half and half that patients and their families know.
A really interesting difference between the primary care doctor/patient relationship and the hospice and palliative medicine doctor/patient relationship is that people whose family members are dying are, in general, not as interested in the doctor. I also cannot think of a time when I had the sense of being a foil for a person when I was being a hospice/palliative care doctor. Their issues are simply different than my primary care patient's issues.
Another really interesting thing is that I have been asked twice by patient family members since I've been back from leukemia whether or not I believe in an afterlife. I have never been asked this before and now I've been asked twice in a month. Both times it felt completely out of the blue, like we were not discussing afterlife or even issues that I would have thought of as spiritual issues. I have no explanation for it.
So, you might be curious what I've been up to today. Kittery with Terry, crossword puzzling, a little weaving and taking Ellie and one of her pals to see "Wreck it Ralph" were the main activities today. You can see why I don't tell my patients much about myself; it's because my life is beautifully, wonderfully boring.
For us all, for tomorrow, I will wish for lifting of the mercury just a little.

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