“You have the nurse hand you the equipment, that way she doesn’t just stand and stare like a chaperone,” my doctoring mentor explained to me before we entered the room to do a pap smear on a young, 35-year-old woman. My doctoring mentor is a middle-aged, 6-foot-5, exceptionally hairy, broad-shouldered man that carries a warm, jovial presence. Yet the reality of the fallen world is that no matter how sweet, happily married, and professional he is — there is an underlying assumption of potential misconduct lying in the room.
“You always let the patient undress themselves — it helps preserve any sense of possible dignity.” With the pap smears, he always lets the woman lift up her gown and/or take off her undergarments themselves, helping only if she’s physically limited to do so. Same with rectal exams: “Always let the man drop his drawers himself.”
“And you want to touch their inner thigh with the back of your gloved hand before the actual speculum exam; it’s a simple gesture to help prepare them, even help relax them, for what’s next.”
They’re simple acts, but all crucial, in building trust during these intimate interactions with patients. It’s a trust that affirms this procedure is normal in a physician’s office, and a trust that asserts what’s being done is for the patient’s overall good.
As I start learning the physical exam, I find myself often apologizing and fumbling over my cold hands. Whether they graze a woman’s breast when taking blood pressure or take too long with an otoscope in a child’s ear, I’m slowly learning my touch is allowed. My hands are meant to poke and prod, rub and press, comfort and care. People — sometimes patients, other times friends, and even strangers — will come to trust my hands. As cold and as small as they are, I’m allowed to do this. This is what they’re meant to do.
Crossing “normal” physical boundaries are only one dimension of the patient-physician interaction. Coupled with that is the steep emotional vulnerability of an honest patient. In 10 minutes, a patient can divulge to me everything from their sexual habits to their bowel patterns to the death of a parent or sibling. I’ll ask them about their happiness, their genital warts, their marriages, their nail-biting. My white coat gives me an express, all-access pass to people’s stories and secrets. This is a pass that comes with responsibilities and expectations, privilege and power.
As I hear more stories and listen to more secrets through my community mentor site, I find myself already being numbed to pain — another mother with a miscarriage, another demented grandfather, another suicidal teen. Interestingly, I realize I have a hint of self-assurance with it. I can handle it. I can compartmentalize. I’m getting better at this. Yet I wonder if these emotional barricades are they way I want to always practice. Without a doubt, they will be needed for my personal sanity and self-care, for I can’t go home still thinking and crying about all my patients. However, in the confines of a doctor’s office, I wonder if my emotions do need to be completely hidden. In all honestly, I believe it’s OK for a doctor to take empathy to another level: to cry with a patient, to share one’s own experiences with illness, to even pray with them if desired. Yes, doctors are hopefully the problem-solvers in the situation; however, that doesn’t mean they can’t sit with you in the pain of the problem itself.
I’m repeatedly realizing my biology textbooks can only get me so far. The role of a physician isn’t limited to physiology and pathology. I believe as a doctor, I also need to understand power, trust, and pain. There’s a lot power in my gloved hands; my white coat is a visual symbol of “trust me,” and a patient’s pain is why we’re talking right now. If I don’t appreciate and acknowledge these, I’ll abuse my power, I won’t build trust, and I’ll ultimately forget why I’m helping you — why I’ve chosen this career.
So whether it be touching the inner thigh before a pap smear or crying with a grieving mother, I’m okay with that. I will do that. I want my patients to trust me. And not merely because I’m a doctor, but to trust me because I’m also simply another human who gets how uncomfortable this nakedness and question-answer sessions are.
Cia Mathew is a medical student.