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  • Community in Dialogue

Meeting and Mis-Meeting In Healthcare Relationships

Barbara R Krasner, PhD


"So how have you been this week?

Up and down. I really don't want to talk about it

D: You have to, I'm your doctor.

P: Well, the fact is, nothing has changed

D: That's not entirely true. You've already Told me

that your back felt better the day after your procedure.

P: OK. You're right

Questions

· What is the difference between meeting and mismeeting between a physician and his/her patient? What context creates one or the other?

o Scott: Physician did not engage or inquire into Scott’s interest to live, who inferred his results were “terminal” VS

o Nurse who referred Scott to another physician who explained the “diagnosis” and the ramifications, which were not terminal

o The patient’s initiative is equally important to the physician’s words

o Austin’s first physician: “Pack your bags, you have two months to live.”

o Austin’s second physician: “it’s not good, but it’s worth a fight.”

o

o A patient’s life/desire to live/approach to life often has a significant impact on their ability to fight

· Are physicians tentative or even frightened about stating a negative diagnosis and take refuge in giving false hope?

· Are physicians frightened of a patient’s reaction?

· Who is there?

· In this attempt at communication, what words does the patient owe the doctor?

· What words or level of conversation does the doctor owe the patient?

· Can a physician afford to recognize his patient as a person as well as broken/defective machinery?

o Any time a physician is engaging a patient, he/she is seeing someone who is worried about his/her life.

§ Often people who are in the caring professions diminishes a patient by turning to a relative and address her as if I wasn’t there

§ Whether I am or not, I deserve to be addressed in the first instance.

§ There are different ways of dismissing people, particularly with respect with communicating information versus using language for a life that is being lived and for which decisions are being made.

§ Frances: “she feels very cared for.” The nurse, receptionist, and doctor are all very sensitive and address her and talk about their lives to a degree

§ In the practice of medicine, given or taken, there is a lot of suffering. You don’t have to be sick to go through that.

· It’s hard to talk about someone’s own life when a physician haven’t been able to reflect on his/her life, including how they are/were treated in his/her profession. Who can they turn to without being judged? It’s a lot of suffering.

§ Become an object very quickly

· “Person first”: how is that playing out in your education and your approach to it?

o The impact of loss takes so much time that when new options appear you are not open to them (or as open)

o Almost all the people have a welcoming attitude

o Minimum graciousness

· Or do symptoms dominate their initial conversations?

· Do physicians try to gather sufficient information about their clients and their contexts to deepen their resources?

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