Mom, what is the one thing you can’t live without?” My six-year-old son asked me out of nowhere one day.
Air? Water? It was a more interesting riddle than usual.
“Love.” He said proudly, not waiting for me to answer.
Wow. He’s right. Love. But if it is the one thing you can’t live without, why are we so afraid of it in medicine – a field that sustains life?
Doctors seldom use the word at work. In fact, I was taught in medical school, as I’m sure most of us were, that a solid professional boundary between doctor and patient is critical. If you lose that boundary, dangerous things happen. We are not to accept gifts from our patients. We block our home and cell phone numbers when we call them, and we seldom give out our pager numbers.
Yet I love my patients passionately. I think about them in the middle of the night. I worry about their kids and wonder how the last week of school went after I made them promise to study more. I feel the crumbling inside me when they talk about the children they left in a faraway country, the ones they talk to every night but have not seen in 10 years. I want to care for the children of the babies I delivered. Primary care docs care for you for life, over your entire family’s lifespan. What does it mean to be there for them for a lifetime without love? I chose not to find out.
I didn’t always feel this way. At first I felt overwhelmed, scared of the passion patients showed for a doctor who dared to care about them. It was hard to know so many people. They quickly knew everything about me and expected the same, and I had hundreds of lives to learn. But over time, and through a thousand urinary tract infections, sore throats, and colds, the familiarity grew. The constant visits, like water flowing, etched grooves into my heart – cascading torrents of emotion at times when I grow frustrated at them, their disease, or both.
So now, along come teams, and not only are the staff allowed to love the patients, but the team model seems designed for it. Teams allow providers the time to focus on their relationship with patients rather than on menial tasks. In so doing, providers increase their face time with patients and develop their own meaningful relationships with them. Independent of the patient-provider relationship, these are person-person relationships. Of course many providers loved their patients all along, but the medical assistant, for example, now has the time and space to officially ask, “How is your family?” “Did you enjoy your vacation? “What grade is your son in now”?
And patients know they are loved at the clinic. The staff all ooh and aah at the new babies. They want to hear the birth stories or how the operation went. Patients notice when the medical assistant has lost weight, taken off a wedding ring, or put one on. This is not wasted time. It is the work we do. We change people, make them care more for themselves and their health by openly caring for them first.
Funny thing is, once you start openly loving patients – once you open yourself – you become more effective, not less. My patients know I love them. I remind them when they are getting chemo. I call them if I have been wondering how they are doing, or I know that I can if I need to. And in return they help me. They try really, really hard to do what I ask. They listen to the advice of the medical assistant. They know her face and some her name. They are so much kinder to all of us when things are busy, or we are stressed, or down, because everyone is a person to them now, not a cog in a machine.
I think this is where patient-centered, team-based care is taking us: both patients and providers become people again, not cogs in a machine. And perhaps the one thing that sets people apart from machines – the one thing we can’t live without – is love.
Kirsten Meisinger is medical director at Union Square Family Health Center in Somerville, MA. She blogs at Primary Care Progress.