Doctors need to be true to themselves, but at the same time, they must be chameleons.
A doctor fills certain roles in the lives and stories of patients. It is a two-way relationship that looks different to each person we serve throughout every workday and even in the most casual interactions we have.
Some patients need us to take charge for a while because they’re exhausted; others need us to listen quietly while they vent or process something out loud.
Some patients need reassurance and empathy; others thirst for detailed information. Some patients thrive on viewing us as equals and friends, yet others need some distance because what they need to share with us is something they couldn’t even tell their best friend – only a priest, rabbi or doctor without the familiarity of a friend.
I may be naturally analytical, intuitive, reserved, or outgoing, but I must get a sense of my patient and the situation he or she is in and understand how I can fit into that situation.
This is not acting or being dishonest. I don’t dress the same way for a day in the office as I do for a day in the barnyard or a night at Chateau Frontenac. Neither do I conduct myself the same way in every situation in my life. It would be selfish and inconsiderate of me to act exactly the same way with every patient: “Take it or leave it.”
I work at being chatty and cheerful, but that is no more dishonest than practicing another language. I may know the perfect word for something in Swedish, but that doesn’t do my English speaking patient any good.
The roles we play in people’s lives are necessary for them in those moments, in their personal journey. Many people need someone in an archetypal role to carry them to the next level or the next chapter in their lives by saying or doing something they cannot do themselves.
Doctors are performers, not only when we perform procedures, but also when we deliver a diagnosis or some guidance. This is the premise of an audiobook I listened to a while ago during my commute between my two clinics: Dr. Bob Baker, a retired physician, and an accomplished magician, draws parallels between the two professions in The Performance of Medicine.
I have done a lot more thinking lately about these two P-words: The Practice of Medicine and The Performance of Medicine. Both words, both concepts, point out that what we do in this job is much bigger than we ourselves are, something that transcends time and place. We have to work at it continually, and it takes place in the energy field of two people in a therapeutic encounter.
Quoting Dr. Baker: “The magic of medicine begins with the doctor/patient connection.”
That connection requires us to be what we Swedes call “lyhörd.” There is no single word I know of in the English language that conveys the same notion. Literally, it means “of keen hearing.” Google Translate suggests three words: responsive, keen, and sharp.
Osler said, “Listen to your patient; he is telling you the diagnosis.” Duvefelt says, “Listen to your patient; he is telling you what kind of doctor he needs you to be.”
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