Healing The Doctor-Patient Relationship Part 1

When I was training to become a physician, the rules of the broken, outdated, patriarchal medical system were made clear to me. They went something like this.

As your doctor, I will sacrifice everything in my personal life in order to fix what is broken in you. I will stay awake when I’m exhausted, cross my legs when I have to pee, ignore my stomach when it growls, neglect my partner and children when they need me, allow my health to decline, and read all my medical journals so I can stay up to date on the latest in modern science. I will show up sick to work, endure unspeakable traumas in order to learn what I need to know to be an excellent physician, and I will prioritize medicine over everything else in my life. I will study what my forefathers have learned, attend lectures, consult with other physicians, practice my skills, follow the Hippocratic Oath, and vow to first do no harm, and then, hopefully, to do some good.

I will ask you questions, take notes when you talk, interpret your vital signs, and listen to the rhythms of your most crucial organs. I will order laboratory tests and X-rays to figure out what’s wrong, write prescriptions to treat you, refer you to a specialist if I can’t figure out what’s going on, operate when needed, and cover up or cut out any symptom that threatens to disable or destroy you.

As your doctor, I will bring to our relationship the hallowed knowledge of the best of modern science, the wisdom I have earned from years spent in ivory towers, the gifts garnered from the most gifted clinicians I’ve trained with, and the hard-won experience of practicing my craft. I will filter your health problems through the lens of my collective knowledge and churn out a diagnosis, a treatment, and a genuine desire to help you get well.

As my patient, you will trust my expertise, refrain from questioning my judgment, have patience when I make you wait, forgive me when I’m curt, keep your questions to a minimum because I’m very busy, and pay your health insurance premiums so I can give you the best care possible.  As my patient, you will comply with doctor’s orders and follow up with all recommended tests and comply with all treatment plans, even if you don’t understand or agree with what I’ve ordered, prescribed, or recommended.

As my patient, you will fill out all paperwork, jump through all hoops, get child care when you need it, take time off work, find transportation, and make any other arrangements necessary to prioritize your health. But if I have to cancel on you, you will understand, because some of my patients are sicker than you.

You will willingly offer up to me every private detail of your life that is relevant to helping me deliver the best care possible, but you may not ask me to reveal such details of my own personal life, for that would be unprofessional. You will not complain about sitting naked and cold in a sterile exam room for 30 minutes, while I attend to other patients. And you will not mind when I finally show up, dressed and perspiring, in my white collar, tie, and starched white coat. 

When you come in to see me, you will forgive me for forgetting your name, not remembering that your husband just died, looking in your ears instead of your vagina because the nurse plugged in the wrong code on my form, and keeping my back turned to you throughout our visit because these computers keep me from looking you square in the eye.  You will understand my frigid hands, the ice cold speculum, and the gown that stops at your waist and flaps open to reveal your business not just to me, but to the people standing in the hallway who peak in when I bark orders at my medical assistant.

You will not get your feelings hurt when I never remove my hand from the doorknob throughout our 15 minute visit, even though you are trying to confess that you’ve had pain with sex for 6 years now. You will understand that I don’t cry when you do, even when I just told you your baby has died, because if I let you see how much I hurt with you, our relationship might get too personal, and you may not respect me any more.

You will understand that if I wasn’t this way, I might wind up even more exhausted, depleted, overworked, overwhelmed, stressed, financially strapped, traumatized, heartbroken, sick, and depressed than I already am. You have to realize that if I put you first without considering the other 40 patients I must see today in my office, I couldn’t pay the bills. And if I put my heart on my sleeve right there where you could see it, I might wind up sobbing on the floor of a locker room, dressed in scrubs, while my colleagues scream at me to buck up.  If I let my guard down, you might see through this gruff exterior and know how much I resent my job sometimes, how frustrated I am that managed care has taken away my autonomy, how disgusted I am that I don’t get more time with you, and how much I feel trapped because I earn one third of what my father earned as a doctor in the 1970’s, when his house cost $70,000 and his overhead was practically nothing.

If I let my guard down for even one second, I might have to admit to myself that I made a mistake, that I should have gone to law school or business school, or that- God forbid- I’d rather be an artist or a writer than this kind of doctor. But I’m an indentured servant who can’t even afford to quit my job, much less follow some lark and go chasing butterflies.

So forgive me if I don’t treat you like my best friend. And understand that I’m really, honestly doing the very best I can.

As doctor and patient, we must agree to respect the boundaries of our relationship, and as long as you do your part, I will do everything I can to fix your problem, even if it saps every last bit of energy I have, because I am called to practice medicine, and I know you need me. So you can count on me. I am here to serve you.

With that said, will you please get undressed now? We only have 4 minutes left.

With the best intentions,

Your Doctor

Okay, it’s me, Lissa, again, and I have to admit that I just sobbed my way through writing that.

Since I start blogging in 2008, I have heard so many traumatic stories from patients, caregivers, and health care providers themselves that I have sometimes felt overwhelmed at the bottomless wound I now call “Medical Trauma.” It feels like opening Pandora’s Box to even point at it, much less explore what might be in that cavernous pit. It’s taken me seventeen years since I left the hospital to feel brave enough to try to touch the wound of medical trauma.

But I now feel ready. Especially since the pandemic, the wound is deep. But ignoring it impairs our healing. So I’ll be teaching a six week Zoom workshop called Healing Medical Trauma. Obviously the wound is too deep to cure the whole kit and kaboodle in six weeks. But it is my hope that we can gingerly approach the wound of Medical Trauma with as much IFS-informed sensitivity, gentleness, and open-hearted compassion as is possible. If you’re a patient, caregiver, or health care provider who has been hurt by the medical system, this program is my deepest offering of love to medicine, coming from the most humble and tender part of my heart.

Medicine broke my heart- and it’s broken many other hearts too in the name of saving lives. Let’s try to heal – together.

Learn more and register now