Monday, June 2, 2008

Doctor-Patient Relationships

I think of myself as a pretty egalitarian person. I have friends with a variety of interests, and a variety of strengths, and in general I feel that we humans are all equal, so I don’t carry a lot of judgment of people who live their lives differently than I live mine. We all have different circumstances, different strengths, different challenges and struggles. We’ve all made different choices about our paths, and we all have different interests and foci that we find important, and that make culture and society such a full and fascinating place.

We can’t possibly know what others around us are truly feeling about their lives—cancer may be easy for me, hard for others. A seemingly excellent, interesting job may be easy for some, hard for others. I cannot assume that my challenges are more important to me than other people’s challenges are to them. It’s an issue that comes up occasionally, because cancer has such hype, but I try to be clear: what challenges you are going through are as big to you as my challenges are to me, and giving me dispensation because my challenge is obvious gives cancer way more power than it deserves.

This is not to say that judgment never comes in—back to the question of choice and control, it’s pretty easy to deem someone’s response to a situation improper simply because we would’ve done something differently. I think this is frequently where people get angry at one another—when one person feels a choice was made without consultation, and which can therefore feel like a judgment. Your idea was going to be bad, so I simply didn’t consult you. I do like to be consulted—it helps with the necessary illusion that we employ most of the time—of some sense of being in charge of our lives.

But these are pretty day-to-day situations. I don’t have a boss, I’m not generally in an environment where I have to even pretend that I think someone’s ideas—and therefore another self—are superior to me. In fact I do like learning, and am avid to pick up skill sets I didn’t have before from experts in their fields, and I feel no sense of inferiority.

Doctor-patient relationships, however, are not egalitarian. I understand this, but I’m not entirely comfortable with it. First of all, when someone consults a doctor, it’s for a basic, fundamental need: health. Without health, without our bodies as our allies, life—choices, activities, relationships—is much more difficult. And so every meeting with a doctor, even a routine physical, can be fraught with tension. Maybe my cholesterol will be high. Maybe the fatigue I’ve been feeling is a sign of something larger than busy days at work and a lack of sleep. Maybe that rash on the back of my arm is melanoma, not just dry skin. It’s easy to freak out.

And then you have the known serious problems, and the real necessity to see highly trained specialists, and the gulf widens. As a linguist, I cannot ignore the semantic framework that also accompanies the relationship: doctors spend years in medical school, and they earn the right to be called “Doctor”. And you, the patient, are “Calin”. Even the most Northwest-casual doctor-patient relationship has that dichotomy. I do now have a couple of doctor friends, and we don’t refer to them as “Doctor” except in fun, like “Doctor Tess”. It’s helped a bit, for me to feel more equal in my skin, to know that they are bright, motivated people like myself, who have simply chosen to focus their supreme skills and abilities in a different way than I have.

But it is strange to be in a dichotomous situation where the only real difference between me and the person helping me is some education and a need. The residents for my needed specialties right now are my age or a little younger, the full doctors are my age. It’s one thing to look at someone who could be your father and call him Dr. Livingston and appreciate how much older and wiser and more knowledgeable than you he is, but it’s quite different to look at Dr. Specht and think of her 18-month-old and wish you could simply be friends and call her Jennifer. I appreciate being able to call Dr. Rockhill Jason, and I appreciate knowing his family. But I found it a little bit difficult to switch to calling the first resident we spent a lot of time with Dr. Loiselle instead of just Chris. He seems like a nice guy—we’d probably like to hang out in different circumstances.

I read once of someone choosing to change her own medical lexicon, calling herself a “client” instead of a “patient”. It makes a lot of sense to me—she is contracting with someone for information and assistance, but is choosing semantically not to lower her value as a person because of her needs. However, “client” does seem a little aloof, too.

There is an obvious comfort in being a patient, in being taken care of, and having a doctor use her considerable skill and knowledge to help you do the right thing. It’s a comfort I struggle with a little, because I am used to making my own decisions and thinking my own thoughts. But I am also coming to recognize that there are clear times when experts deserve our full attention, and our full commitment to them.

Maybe someday Jennifer and Chris and I will all be friends, but probably not. But that’s okay.


Andrienne said...

Calin, such a fascinating reflection on semantics. I guess I wonder if you would feel more comfortable calling your doctors by their first names? You are equal partners in your progression toward health - their expertise, and your love of transforming perceptions. You made me realize how lucky I am that I had a doctor with whom I was on a first name basis. She was a fan, actually, so in a weird way I had the upper hand of some kind of social heirarchy when she started treating me. I did like the intimacy it seemed to infer. Thank you for the insight.

Anonymous said...

The first chemo treatment was over and the side effects were minimal.We went away for a week of vacation camping and not having to think about"cancer".But then the hair started coming out and that was a first constant visual reminder that something was going on.We went to a 4th of July picnic--not bald yet but still shedding--still a constant reminder.Another guest had forgotten to pick up the whipping cream for her salad and had to make an unscheduled stop to pick up some and was still grumbling about it.Such a small thing compared to what we had to deal with.But for her it was a big thing--and I learned to appreciate others challenges--no matter how big or small they might seem to me.Your entry reminded me of this time.