Medicine's Missing Center: The Failure to Engage

I'm trying to think about what happened.

First of all, I can imagine a situation where the note is mostly drafted before you even come into the room.

So to speak about how things happen in medical records, it might have been that it would require a very positive, different act for the medical resident you work with to then edit the note and change the narrative and start reconfiguring.

And we could speculate.

We could also speculate that there hasn't been much discussion about trauma influences pain experiences in patients.

in that particular learner's life.

But you and the resident were in the same room.

You were trying to help, both of you.

What do you think happened between you and the patient in a nutshell that maybe didn't happen before?

I think that when I walk into a patient's room, particularly if I feel like the patient is suffering or struggling, I want to connect.

And I have to reflect on why that is.

I think that connecting with people in general is something that makes me feel good.

But at the same time, I also want to make it clear that I haven't forgotten that I'm the doctor and that the patient is the one who I'm there to take care of and to care about.

And so I don't want to imply that I'm going in there wanting to connect just because I I want to feel good for my own sake.

It's about wanting to create a dynamic between me and the patient that will make them comfortable and open and that that will be gratifying to me to see.

One word you didn't use is friend.

I don't hear you saying, I'm trying to be the patient's friend.

Should I hear you saying that?

I'm glad you brought that up because many years ago, when I was having a conversation like this with a colleague of mine who is a scholar of the doctor-patient relationship and had written quite a bit about it, and I kind of brought this up, she replied exactly that way.

She said, you know, my patients are not my friends.

It was interesting because I never had said to her that I thought that the patient should be your friend.

The idea of a friend itself is a construct.

What does it mean for somebody to be a friend? And so even there, I'm left at a little bit of a loss about how to respond because I don't think that a doctor and a patient can't be friends.

I don't go in there to make a friend, but I don't think there's anything wrong if a doctor and a patient become a friend.

I think we have to decide what that term means.