This post from Kelly Young on Howard Luks’ blog asks when patients cross the line with respect to their own advocacy. It’s worth a peek.
The question of boundaries between doctor and patient is interesting. All of my patients are empowered in some way. The extent and level of that empowerment is personal. On our own there are few lines and little with respect to boundaries. We have effectively unlimited access to information and resources. And how far we go to look after ourselves and our kids has few limits.
But when we enter into a relationship with a provider, we’re no longer alone. It’s unreasonable for a provider to tell a patient exactly how it will be. It’s unreasonable for a patient to tell a provider exactly how it will be. Every great doctor-patient relationship is unique and lines that define that partnership need to be identified. In this context both providers and patients can cross a line that makes the relationship ineffective. And in this case the other party needs to decide whether the relationship works.
In our working relationships with patients we need to draw lines that define our role. Good fences, after all, make good neighbors.
{ 3 comments }
Agreed, Bryan. There is, and should be, a line.
I see the doctor-patient relationship as two professionals, collaborating on a goal. You are the professional with medical knowledge, experience and sense. I am the professional of my body knowledge, experience and sense. Together we should be able to sort out the problem and fix it.
The line that should not be blurred is which one of us has which expertise. You have education and experience. You are the expert in body systems and disease. As my doctor, I see you as my #1, most important resource when I have an issue with my health.
But you are not the expert of me. I am the expert of me. I know far more about me than anyone else. You will never have nearly the same knowledge about me as I do.
Even if I, as the patient, go online to improve my knowledge about any aspect of the experience, it does not subtract from your role as the expert in knowledge and experience. Nor would you be more of an expert in me if you read all my medical history – or even my high school yearbook. Granted, each of us would have acquired more information, perhaps worth a discussion, but it doesn’t change our roles or expand our overall expertise.
So that’s the line – respect of who holds, and can apply, which knowledge. A respectful collaboration with that basic foundation will mean a great working relationship.
Trisha Torrey
Every Patient’s Advocate
“But you are not the expert of me. I am the expert of me.”
Just want to point out that this often doesn’t hold true in psychiatry. Most psychiatric patients seek care because they are *not* the experts of themselves. Quite the opposite, usually.
What is ENTIRELY reasonable is for a patient to tell a provider their values (& fears, and what has and hasn’t worked in the past and let the provider spit out the bones) and trust that they can work together from there.
LISTENING usually helps. Deciding that a line exists before listening sets everyone up for failure. When a patient tells a doctor EXACTLY how it will be, they are usually coming from a place of GREAT fear. Often because in the past something hasn’t worked, or they have been deeply abused, or, it is BRAND NEW and they are terrified. (child birth, new diagnosis, etc). When a provider bristles and says, “my way or the highway” without realizing the patient needs talked down (or perhaps reached out to) everything becomes adversarial. Great personalities can usually be very well matched.
This whole thing about “lines” (from everywhere I’m reading it) has me treading softly. The loudest patients are usually the ones with the most fear, (not the biggest egos).
cheers!
Melissa