Why Starting a Relationship With a New Doctor Is Like Dating
A friend recently called to ask for advice about how to react to an order written by a new physician for her son. At the time, her son was hospitalized following surgery to place an ileostomy. The gastroenterologist had recently introduced the concept of tracking “ins and outs” to my friend, and as a part of that, the GI team also began to teach her about replacement for fluid lost and maintaining hydration. Specifically, she wanted to know if she should push back against the order.
She shared the frustration she and her husband felt that they were slowly moving in the direction of a place where fewer and fewer physicians and healthcare professionals truly understood their son. She said her son had never received any fluid at the rapid pump rate that was just ordered to allow her son to receive water through his j-tube. And so, she asked me, should I push back and tell them no?
It’s easy to feel alone in this situation, alone in the middle of a hospital filled with people and alone in the healthcare system. This is especially true when patients and families must manage chronic illness, special health care needs and/or disability. I was struck during and after the conversation about how quickly my friend went into battle mode: us versus them.
While this may have been her innate fight-or-flight response kicking in during a difficult time, I had to wonder, how much of this is taught? Taught in the school system and the pursuit of special education. Taught in how we too often define “advocacy” as a fight. Taught through sports. While a competition is at its core a battle for the win, why, in healthcare, do we turn that competitive edge onto our own teammates? Why do physicians and patients and family not view each other as teammates as readily as they view each other as foe?
In saying that they don’t understand or know my child, this friend moved into us-versus-them mode. This automatic shift happened because the parents do not yet have a mutually beneficial relationship with these new physicians. Because the physician most likely operates in the way physicians have been trained for ages: diagnose, treat, next patient. Instead of engaging the patient and family to share their goals and help develop the treatment plan (beyond requesting report from the family), the “relationship” is solely paternalistic.
There is no relationship or team in this situation, or at least not yet.
As we talked more about the newness of this GI team to her son’s care, I was struck by how much the relationship between physician and patient and family goes through a courting ritual not unlike the what my husband and I did prior to marriage. Historically, courting is the phase of a relationship when a couple gets to know one another and decides whether or not they will move on to engagement and then marriage. While Hollywood portrayals of courtship are full of hearts, candy and roses, for most of us the magic and romance is mixed in with some heavy doses of reality.
The courtship dance
A physician consult room or office is not unlike the table where you sit during your first dinner date. You are checking each other out, investigating and exploring. There is listening and lots of talking and sharing. There is flirting, puffing, strutting, etc.
Although a spin around the exam room in a waltz is unlikely, there is a choreographed movement between patient and physician just as intimate as sharing a dance, holding hands or even a first kiss: the physical exam. It requires getting to know one another first. It requires trust to expose and share very personal details and allow physical examination. In the end, we enter into this dance in the exam room for the same reason I did decades ago during drinks in a bar in New Orleans with my husband; because we hope it is the beginning of something good (beautiful), beneficial for both and a long journey together full of health, happiness, strength and support. OK, and sometimes a little magic, too!
Swapping life stories
You know a date is going well when the conversation flows. You each show genuine interest in each other and share about anything and everything. You say things like: “I feel like I have known you forever” or “I could talk to you all night” or even “I want to know everything about you, what makes you happy, sad and scared, etc.” Sadly, however, many of us have had dates where talking flows but it only flows in one direction, and life stories of both are not shared.
Many times a medical exam is just like this less-than-desirable date — and the one-sided flow is not by choice. The patient and family often feel on the hot seat or like they are in an interrogation. Unlike a romantic date, the life story swap in an exam room will not be complete for both parties. And that is OK. To be able to trust, conversation must flow both ways, be honest and open. A facial expression, hand on a shoulder or earnest listening go a long way in expressing sincerity and caring. A physician who oozes genuineness and empathy, and maybe shares about their dog or love of music (because the patient or family did, too), is making connections and forming bonds.
Meeting the family
When you meet someone, there is a period of bliss when it is just the two of you, and then you meet the families. For some families, the introduction is like discovering long lost siblings, whereas others are like oil and water. Bringing the extended family into the basic physician-patient (and parent for minor children) relationship can be bumpy as well. The dynamics often shift dependent on varying degrees of knowledge, understanding, goals and agendas. This shift change may be just as true for the nutritionist, psychiatrist, grandparent or cousin brought onto the patient’s team. Thankfully, just as in familial relationships, love and communication never fail in a physician-patient/family relationship.
Saying things you don’t mean and omitting things you do mean/should say
I am the first to admit that I said not-so-nice things to my husband when were dating to test if he would stick around. I also omitted things for fear he would reject me. And when I got over my fear of rejection and leaving, I still said not-so-nice things or omitted perceived “uglies”… but because I felt safe, respected and had trust. In a physician-patient/family relationship, things are said or omitted, too, but more often than not it is because of a power difference. Physicians omit details because they think a patient won’t know or understand. Patients/families omit information because they are intimidated by the doctor or afraid they cannot say something “correctly.”
Both say things they don’t mean because of misperceptions of the other (for example, like telling each other what think they want to hear). The key in both relationships is not allowing what is said or not to bog us down so that we don’t rely on the strength of communication, respect and trust.
The first fight
When it happens, it feels like life is over. You rethink every move in the courtship dance, everything you have shared and every promise, decision or plan for the future. Many times you are ready to walk away because the hurt is too deep, the disagreement too severe or communication too broken down. Threats of leaving or betrayal fly. All this is true in a physician-patient/family relationship as well (including the threats). And just as its romantic counterpart, the physician-patient/family relationship can survive a fight.
Disagreement is often a necessary phase of conversation, especially within a relationship based on respect, caring, trust and shared decision-making. Quite often it helps us to grow and strengthen in ways we never saw possible before. While I’m not advocating picking a fight with your doctor or partner to foster creative, new forms of treatment or activities, it is better to keep the communication flowing. Often as patients/families, we come to either fear the “white coat” or assume we are not on the same side. This dynamic lends itself to fights rather than discussion. Just as a romantic relationship is often called a partnership (or team — my husband, kids and I call ourselves Team Coleman Chaos), so too should a medical relationship. Putting all thoughts, feelings, fears and goals on the table in a physician-patient/family relationship may cause tensions at times, but ultimately it fosters partnership and teamwork.
I have often thought about what I would have wished someone would have told me about life and relationships when I was young and free in college. I am not sure I would have listened, but I now know what those two things are: flexibility is the name of the game and change is the only constant. My husband, in fact, told me the latter when we were first dating and I was still holding firm to my type-A personality, and it infuriated me. Because change is the only constant, I have learned to be flexible with my husband, with my kids, with my daughter’s illness, with judgment and inconsiderate comments of others, with physicians and her health team, etc. Flexibility enables you to ebb and flow with life rather than staying stagnant while change happens all around you. It also enables you to hear and see other people such that compromise can be reached, everyone’s needs are met and communication remains paramount. While the saying “happy wife, happy life” is funny (many days very true), a relationship grounded in compromise is more likely to make sure everyone is happy and stays in the relationship.
There are so many other ways in which a relationship with a physician, or any other health professional for that matter, mirrors romantic and every other human relationship we have. That is because we are just that — human. We are not experts, all knowing, Gods, miracle workers, omnipotent, perfect, etc. We need food, shelter and love to survive. We invite others into our lives and on to our teams to help us on our journey through life. We hope they bring all the magic, flowers, hearts and candy of Hollywood. And we know that with these partners, spouses, physicians, families, etc., we will be able to handle all of the realities of illness, challenge and death that come our way.
Lead photo source: Thinkstock Images