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
· 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 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?