I expect my patients to develop or sense responsibility in connection to their health because I believe personal responsibility creates the basis for a constructive, therapeutic relationship and healing process.
My experiences as a patient have made me understand how difficult it can be to maintain a sense of responsibility. I often yearn for clarity and a “gameplan,” but instead find myself confronted with medical guideline gray-areas and conflicting treatment recommendations. Not knowing or sensing a clear path has led part of me to want a cardiologist to create one for me. I say create one because the medical guidelines don’t provide much guidance and none of the cardiologists I have gotten to know as a patient or colleague have seen more than a few if any patients with my disorder.
Most people are unaware of how much of medical practice is based on clinical experience as opposed to randomized controlled trials. It may sound strange, but there are countless contexts in which medical guidelines are not black and white. In cardiology, for example, it has been estimated that only about 10 percent of the cardiology treatment guidelines are based on the results of randomized controlled trials and meta-analyses. This reality often causes the advice patients receive to be colored by personal experience, tradition, and sometimes even the fact that medical institutions are paid for providing services.
I became most conscious of a sense of disorientation and helplessness after telling my current cardiologist (I’ll call him Dr. G) I felt well-informed and responsible. At the time, I wanted to communicate that I felt responsible for my medical decisions, particularly because I believed the colleagues he had discussed my case with could be quick to pass judgment if he didn’t convince me to do the “right thing” before it was “too late.” In other words, I wanted to eliminate the possibility of receiving a fear-driven treatment plan.
As I communicated with Dr. G, I was cognitively aware of my responsibility but didn’t know how to embrace it. I wanted to understand my medical situation as best I could, but also began to realize that understanding wouldn’t be enough. I needed to begin relating to my mortality more deeply and finding ways to trust my process.
Thinking about responsibility in the patient-practitioner relationship has made me consider how complex the responsibility of a physician is. One of the first things that Dr. G said to me was that he could not put himself into my situation. At the time, I thought he was trying to communicate that my situation wasn’t straight forward. I felt frustrated that he avoided answering my question about what he would do if he were in my position and I wondered whether it was the young physician sitting next to him that kept him from sharing his personal perspective. In hindsight, I realize that while part of my frustration was surely related to the irritation of not having my question answered, much more of it was rooted in my desire to find orientation through his words.
Although I find it helpful to honestly reflect a decision as if I were in my patients’ shoes, I am glad Dr. G didn’t send me home with a hypothetical, personal gameplan. I want to find my orientation in a way that doesn’t pull him into my decision-making process or change his sense of responsibility towards me or my sense of responsibility towards myself.
Maya Cosentino is a child and adolescent psychiatry resident.
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