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The Doctor-Patient Relationship: Part One

Lissa Rankin's picture

Old Medicine

When I was training to become a physician, the rules of the broken, outdated, patriarchal medical system were made clear to me. They went something like this.

The Old Medicine

As your doctor, I will sacrifice everything in my personal life in order to fix what is broken in you. I will stay awake when I’m exhausted, cross my legs when I have to pee, ignore my stomach when it growls, neglect my partner and children when they need me, allow my health to decline, and read all my medical journals so I can stay up to date on the latest in modern science. I will show up sick to work, endure unspeakable traumas in order to learn what I need to know to be an excellent physician, and I will prioritize medicine over everything else in my life. I will study what my forefathers have learned, attend lectures, consult with other physicians, practice my skills, follow the Hippocratic Oath, and vow to first do no harm, and then, hopefully, to do some good.

I will ask you questions, take notes when you talk, interpret your vital signs, and listen to the rhythms of your most crucial organs. I will order laboratory tests and X-rays to figure out what’s wrong, write prescriptions to treat you, refer you to a specialist (if I can’t figure out what’s going on), operate when needed, and cover up or cut out any symptom that threatens to disable or destroy you.

Trust Me

As your doctor, I will bring to our relationship the hallowed knowledge of the best of modern science, the wisdom I have earned from years spent in ivory towers, the gifts garnered from the most gifted clinicians I’ve trained with, and the hard-won experience of practicing my craft. I will filter your health problems through the lens of my collective knowledge and churn out a diagnosis, a treatment, and a genuine desire to help you get well.

As my patient, you will trust my expertise, refrain from questioning my judgment, have patience when I make you wait, forgive me when I’m curt, keep your questions to a minimum because I’m very busy, and pay your health insurance premiums so I can give you the best care possible.  As my patient, you will follow up with all recommended tests and comply with all treatment plans, even if you don’t understand or agree with what I’ve ordered, prescribed, or recommended.

As my patient, you will fill out all paperwork, jump through all hoops, get child care when you need it, take time off work, find transportation, and make any other arrangements necessary to prioritize your health, but if I have to cancel on you, you will understand, because some of my patients are sicker than you.

Tell Me Everything

You will willingly offer up to me every private detail of your life that is relevant to helping me deliver the best care possible, but you may not ask me to reveal such details of my own personal life, for that would be unprofessional. You will not complain about sitting naked and cold in a sterile exam room for 30 minutes, while I attend to other patients. And you will not mind when I finally show up, dressed and perspiring, in my white collar, tie, and starched white coat. 

Forgive Me

When you come in to see me, you will forgive me for forgetting your name, not remembering that your husband just died, looking in your ears instead of your vagina because the nurse plugged in the wrong code on my form, and keeping my back turned to you throughout our visit because these new computers keep me from looking you square in the eye.  You will understand my frigid hands, the ice cold speculum, and the gown that stops at your waist and flaps open to reveal your business not just to me, but to the people standing in the hallway who peek in when I bark orders at my medical assistant.

You will not get your feelings hurt when I never remove my hand from the doorknob throughout our 15 minute visit, even though you are trying to confess that you’ve had pain with sex for six years now. You will understand that I don’t cry when you do, even when I just told you your baby has died, because if I let you see how much I hurt with you, our relationship might get too personal, and you may not respect me any more.

Please Understand

You will understand that if I wasn’t this way, I might wind up even more exhausted, depleted, overworked, overwhelmed, stressed, financially strapped, traumatized, heartbroken, sick, and depressed than I already am. You have to realize that if I put you first without considering the other 40 patients I must see today in my office, I couldn’t pay the bills. And if I put my heart on my sleeve right there where you could see it, I might wind up sobbing on the floor of a locker room, dressed in scrubs, while my colleagues scream at me to buck up.  If I let my guard down, you might see through this gruff exterior and know how much I resent my job sometimes, how frustrated I am that managed care has taken away my autonomy, how disgusted I am that I don’t get more time with you, and how much I feel trapped because I owe more money than I’m earning these days.

If I let my guard down for even one second, I might have to admit to myself that I made a mistake, that I should have gone to law school or business school, or that - God forbid - I’d rather be an artist or a writer than this kind of doctor. But I’m an indentured servant who can’t even afford to quit my job, much less follow some lark and go chasing butterflies.

So forgive me if I don’t treat you like my best friend. And understand that I’m really, honestly doing the very best I can.

Capiche?

As doctor and patient, we must agree to respect the boundaries of our relationship, and as long as you do your part, I will do everything I can to fix your problem, even if it saps every last bit of energy I have, because I am called to practice medicine, and I know you need me. So you can count on me. I am here to serve you.

With that said, will you please get undressed now? We only have 4 minutes left.

With the best intentions,

Your Doctor

Okay, it’s me, Lissa, again, and I have to admit that I just sobbed my way through writing that.

I’m going to propose a new agreement, one that will forge the way and shine a light on Pink Medicine - a system I dream of and believe in my heart-of-hearts is possible.

Since I have decided to put my white coat back on, I am committed to rewriting the rules, shaking up the system, and tapping into my gifts as a physician while doing things my way.

To learn more about my philosophy and to receive the 10 Keys to Optimal Whole Health click here.

What do you think? Have you experienced any wounds at the hands of doctors or other health care practitioners entrenched in The Old Medicine? Are you a doctor or other health care professional committed to changing how we treat patients? Are you a patient ready to demand what is rightfully yours? Who’s on board to blaze this trail with me? Can I see a show of hands?

Bueller…Bueller,

Lissa Rankin, MD

Lissa Rankin, MD: Founder of OwningPink.commotivational speaker, and author of What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend and Encaustic Art: The Complete Guide To Creating Fine Art With Wax.
 

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Comments

Katherine's picture

At times, I've experienced more degradation than trust...

Lissa, your blog has certainly hit a mark with me. I have had to put my trust into many doctors, as I've moved quite a bit because of either my job or my husband's. And, oh my goodness, my emotional and physical health have suffered. I draw attention now to the emotional because I've actually been intimidated, overrun and physically hurt because of doctors that felt that they simply knew more about me than I did. And, because of some of those instances, I find it difficult to trust other physicians in the same field. My past experience with dead-pan faces, fast talk and quick decisions to provide in-office procedures (that were painful but didn't help) has led me to believe that some doctors are simply unethical. Just plain incompetent and unethical. But, thankfully, I've lived in the same place for over 10 years now and have found a wonderful practice and doctors that epitomize "good health care." Thanks, Lissa for this blog because now I feel that awareness is heightened and that I was not alone.

Julia Ringma's picture

my own best advocate

I left a long comment on Care2 - hope you get it!

I had to comment here because the "Bueller, Bueller" at the end made me laugh out loud. Thanks.

Michelle Medina's picture

Consistently I've experienced

Consistently I've experienced this, or watched other people experience this!!! ARGH!!! I am thrilled your reaching out for new medicine Lissa!!!! I know I've said it before, but my stepmom almost died and is now home with us, and of course you know my own history with surgeries, so this really, really strikes me. I can understand why you sobbed your way through, because my feelings are completely in line with that emotion right now!! I love and respect you tremendously! Thank you!!!

Carz's picture

A different system

In Australia we have a vastly different health care system, largely subsidised by the government. This makes it more affordable for most people to get the care they need, although unless you have private health insurance seeing a specialist or having non-emergency surgery can involve a long wait. I am grateful for the system we have but there are some issues that I think are universal.

I have had my share of bad experiences with doctors, usually general practitioners - GPs (family doctors) including one who, on examining my ankle, completely missed the five inch surgical scar from an earlier reconstruction and one who refused to write me a referral to a psychologist for anxiety and depression without first running blood tests to look for an organic cause, despite having been told that I was, at that stage, living with a partner who was sexually assaulting me on a regular basis (I found out recently that the same doctor tried to prescribe anti-depressants for a friend only a week after she had lost her mother, completely ignoring the fact that grief is normal and expected and all my friend wanted was someone to hear her). I have also had some amazingly positive interactions with doctors. My current GP is a wonderful woman who takes the time to really listen to me, my needs and my fears, and to take them into account when looking at what needs to be done.

Perhaps one of the most amazing times was when my newborn son was admitted to the Special Care Nursery two days after initial discharge for dehydration because my milk never came in. A doctor who I knew, in passing, from other areas of my life saw patients at the same hospital (she was what is termed an obstetric GP). She saw me in the cafe the day my son was admitted and took time out to come and have a chat. When she found out what was going on she made the effort every day, when she was in seeing her own patients, to pop into the nursery and have a chat with me, something that the nursing staff and paediatricians really didn't have time to do. It meant a lot to me, and still does, that she would do that. If I was building a dream doctor they would have a good dose of that compassion and care in the mix.

Personally I think a lot of what is missing in medicine is the acknowledgement that we are all people first. Some are scared by what is going on in their body or mind or life in general and others are battling the demands that their chosen careers place on them and the impacts that has on their lives. I think that if we can all take the time to remember that the person we are seeing, doctor or patient, is a person first then that would make a huge difference.

etsen's picture

humane health care

I'd love for this human-to-human relationship to be more obvious overall. It can be rough when the first thing you are handed in an emergency situation is the paperwork (one time i accidentally cut open my palm while doing a chore, and i was handed the paperwork as soon as i got to the desk, and i couldn't use my hand to sign, etc.) I've been blessed with good gynos, but some have assumed things that made me uncomfortable ("why don't you want to have children"? "why aren't you married if you have a partner?"). My first experience in a gynological setting, two males came in to crack crude sexual jokes; only moments later they wanted info about my birth accident (partial paralysis of eyelid and face) in the middle of it all. Ditto at a dental appointment; i had to ask "What does this have to do with my teeth"? Feeling like a real guinea pig when it happens, not a feeling human being, and paying out of my own savings for services .

etsen's picture

humane health care

I'd love for this human-to-human relationship to be more obvious overall. It can be rough when the first thing you are handed in an emergency situation is the paperwork (one time i accidentally cut open my palm while doing a chore, and i was handed the paperwork as soon as i got to the desk, and i couldn't use my hand to sign, etc.) I've been blessed with good gynos, but some have assumed things that made me uncomfortable ("why don't you want to have children"? "why aren't you married if you have a partner?"). My first experience in a gynological setting, two males came in to crack crude sexual jokes; only moments later they wanted info about my birth accident (partial paralysis of eyelid and face) in the middle of it all. Ditto at a dental appointment; i had to ask "What does this have to do with my teeth"? Feeling like a real guinea pig when it happens, not a feeling human being, and paying out of my own savings for services .

Ade's picture

I am just tossing this in. I

I am just tossing this in. I thank you Lissa to your response to me. I have been doing better, in part, because your commentaries put me at great ease. The fact that you're out there as an advocate for doctors as well as patients is a gift to all. I am happy that someone is out there saying what needs to be said.

Like I said before, I can be all too forgiving but, perhaps (as I always tend to question myself) that we are all just too human. I think this is a very difficult and senstive topic all around, and generally. I honestly think, though, that yes, there needs to be a great deal of change in the way medicine should be practiced but we should all take in consideration that we are all different. I have many friends who are very capable of brushing off curt or indifferent behavior from a doctor or someone in the medical profession. Some people are more scientific and less emotional. For that reason, it is important to shop around, as Lissa has said often in other blog posts. The biggest problem here is not doctor vs. patient. It is people vs. government and all of these problems we are encountering is due to lack of funding and proper representation. As the population grows, new laws passed...insurance and financial crisis' emerge...we are going to see a deterioration in our health care system. This is why it is important to vote and find proper representation, so that we can reform the health care system to work as best as it can for everyone, doctors and patients alike. We are so quick to blame doctors for their indifference or lack of care but we are always going to encounter doctors like that. It's the doctors that are being forced to treat their patients this way because they have no other alternative. They also need to pay their bills, feed their children, find the same solutions to every other problem like we do. It's a very difficult position to put in. I do appreciate that because I work very hard at my job and there's less and less money coming in and my insurance rates keep going up. So, even though I get angry at my doctor, I fire him or her and find another until I find the right one who suits my needs...and I vote, I fight...and forgive. If I just accept things for the way they are, and keep seeing the doctors that don't care for me right, I just keep giving permission to keep it all the same. I'm willing to make the sacrifices necessary to change the system. This is what our forefathers and mothers did for us.

Colleen D's picture

Distrust & Doctors

I've been battling with doctors for 15 years and I'm only 29. For 15 years, I've dealt with severe abdomanial pain. The doctors diagnosed it pancreatitus for years and I have a new doctor who says that's incorrect. So I'm back at square one and in a flair up that it feels like it will never end and that I'll never get answers. To top it all off, at the last appointment I had my doctor suggest therapy because I got emotional in his office again. Personally I don't think tears of frustration due to the unknown and the hardship of dealing with pain and nausea with no answers or guidelines on how to heal myself means I need to seek therapy.

While I usually trust my doctors, I distrust the medical establishment. I dread having to make an appointment and trying to make a doctor believe me that the pain is real, the nausea is intense, and I don't know what to do, only to be told "there's nothing we can do, you have to live with it." I try to be understanding of their busy schedules but I feel like they don't care if I have another week of intense pain before they can see me. They don't care that it's hard for me to work or even sit up somedays.

Without a diagnosis, I feel lost. How do I research ways to heal myself if I don't know what the true problem is? I've been trying to practise radical self care, but how can I when my syptoms match 15 different diseases? The waiting game is scary and uncomfortable.

Anonymous's picture

Am trying to be empathic, but it's really really hard....

Lissa:
Appreciated the effort and thoughtfulness you put into
this blog post. I get that physicians are in horrible binds,and empathize with their despair.

All that said, I am still reeling from a recent surgery (one that I had prepared for months because I knew the surgery would test me emotionally--and I had been very upfront with my surgeon about my concerns--giving the surgeon ample time to decide if I should even be on his caseload). One day after the operation, the surgeon informed me (while I was in the ICU and semi conscious from all the pain meds I was on), that he was taking off on vacation, and that he would be out of town for 14 days. The surgeon nor his staff informed me beforehand that the surgeon would be leaving town one day after my surgery (even though I was informed I would be on the inpatient service for 4 to 5 days).

I felt profoundly disrespected, and furious that I had not been told of the surgeon's departure before my scheduled surgery. I would have never, in a million years, scheduled the surgery when I did, had I known the surgeon would leave early in my hospitalization, and not return to attend to my post op care until 12 days after leaving the hospital.

I had met the surgeon a good 15 months before surgery had been scheduled, and met with him about every 6 weeks (and more often about 2 months before surgery because of some medical issues that had cropped up)to discuss the surgery and my fears. I felt that the surgeon's unexpected departure made my recovery so much more challenging than it needed to be because I was so upset by his unexpected departure.

I have done my best to forgive his one day post ICU departure, but I still have moments that are really hard, and my trust in this surgeon, and in other physicians, still feels shaky, even though it is a good year and half since I had the surgery. What really burns me, though, is that the surgeon's associate, the person assigned to keep an eye on me while in the hospital, could not handle how upset I was about his senior physician leaving without notice, that he proceeded to bad mouth me in my chart. Fortunately for me, I came out OK physically, but the emotional "burns" from that surgery, still linger, and it is so frustrating because
I still feel haunted by the disrespect and lack of empathy/consideration shown to me. I hate feeling this way, and do what I can to "let it go," but the resentment still leaks out, and then I get down on myself for my reactions/flashbacks to that surgery.

I know physicians, more often than not, are between a rock and a hard place, and this really sucks. It is amazing to me, that physicians are still standing, given the adversity they endure. I don't think I could endure half the indignities you wrote about, and I feel that many physicians are heroic, because they march on day after day, despite their own terrible wounding and self-neglect.

I just wish my mother had not trained me to put physicians on such a pedestal--and I am also mad at myself for having forked over so much of my power to a fallible/man, a surgeon with feet of clay. I am attempting to view my adversity in the doctor-patient relationship, as an opportunity to not idealize accomplished individuals in the intense way that I have been trained to do. Most importantly, I am learning to rely on myself for my emotional well being, and to enter into a doctor-patient relationship with a bit more skepticism, distrust, and emotional distance.

Lissa, thank you for raising this important topic, and for giving me a forum to share what happened in my last surgery experience, and to honor my feelings about the experience, even though I feel judgmental and impatient with myself for not entirely "being over it."

Looking forward to what you have to say in part II. Really appreciate your honesty, integrity, and your willingness to think of win-win treatment models for both patients and physicians. I am excited to see what you come up with, and I have faith you are going to transform our health care system out of the dark age (in an emotional sense, especially).

April Cooper's picture

Change is desperately needed...

It took 10 years and more doctors (and procedures) than I can remember for me to get a diagnosis for something that turns out to be a fairly well known and documented health condition (PCOS). Since the diagnosis I've been able to manage my condition and get my cycle on track through mostly natural/alternative means.

I believe it took so long because the doctors weren't really paying attention to me and my symptoms, they were just getting me in and out the door as quick as they could.

As to being wounded by a doctor, I had an on-call OB-GYN come in while I was laboring and my cervix wouldn't dilate past 3 centimeters. He put his hand inside me and forced my cervix open without even telling me that's what he was going to do. It was incredibly painful and traumatic, especially in the midst of an already difficult birth experience.

Lissa - I am so very grateful that you are spearheading a movement to change medicine and make it a practice that honors the humanity of both doctor and patient.

Hugs, April

Kate's picture

I'm back again today. Your

I'm back again today. Your posts are just so inspiring.

I feel badly, because I am the patient that is now super-forward with what I need and want when I walk into a doctor's office. Sometimes, I worry that I'm being rude. But let me tell you, I'm done with being a lamb. Because I've had enough.

When I was 22, I moved to a new city to get my first job and, little did I know, the biggest education I would ever get about fighting for myself. I had horrible gallstones which took them a year (yes, a YEAR) to even check for, and then diagnose. We'll ignore the fact that I asked about it earlier on and was told no. I was dismissed by nutritionists, specialists, primary care doctors, and everyone in between. I had a nurse stop dead when I gained 25 pounds because I could eat again, and I had a receptionist look at me like I must be faking when I told her I was concerned about my PCOS and family history of diabetes. I've had doctors tell me that if I "just lost weight, my problem would go away," and that since they couldn't find a reason why I was in pain, it must be something having to do with another specialty (GI vs. GYN). End result? I'm still in pain. And when I finally found a treatment that might work, I was told that I better hurry up if I want to have kids because it will take a long time. Never mind that I can neither afford the treatment nor a child right now.

Bottom line, I love and respect the field of medicine, but I have begun to view the medical establishment with distrust, which I hate doing. But, I need to be treated with gentleness and compassion. Please don't tell me that I'm too young to have gallstones when I've had an attack in the middle lane of the PA turnpike going 70 mph by myself. Please don't tell me that you don't have time or you don't believe me when I'm in a new city all by myself with no one to rely on but myself. Please believe me when I say that I know my body. I will trust you if you trust me, too.

Thanks for being a light, Lissa.

Lissa Rankin's picture

Thank you Ade and Kait

Ade, oh honey- on behalf of doctors everywhere, I'm SO SORRY, my love.
Things are changing. We must be the change.

And Kait, you are the future of medicine. I believe in you and need you to stand against this with me.

Together, we will all prevail in reclaiming the heart of medicine.
With great love and hope for the future,
Lissa

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Kait's picture

I'm facing a hallway of chemo patients right now

and holding back a stream of tears that will come as soon as I am somewhere private.

This morning two more docs BALKED at the idea of discussing sexuality/sexual dsyfunction, etc with their patients. One was freaking because their research protocol requires them to discuss contraception.

SERIOUSLY?!

Anger rose within me and I had to walk it off so as not to scream at anyone. Why are we ignoring so many important aspects of our patients? Your young male patients with testicular cancer undoubtedly have questions and concerns about their sexuality. The same can be said for your patients who are grandmothers.

You know how close to my heart issues of sexuality are...I finally just started chanting VAGINA VAGINA VAGINA in my heard circa this weekend and felt better...but there are so many other issues that are going ignored (that is the whole POINT of the study that I'm working on). It breaks my heart that even as a researcher I'm forced to keep pushing and get our numbers up when what I really want to do is hang out on the chemo floor and chat with the amazing men and women who are successfully fighting this battle and who just want to talk to someone who asks them the questions no one else will.

Rant over. I'm thankful for this post and can't wait for tomorrow's...I'll make sure I'm somewhere that will allow me the privacy and peace to sob freely.

<3

Ade's picture

I'm right behind you Chica.

I love this. I love how you show both sides of the spectrum. I am the kind of person who's always searching for good in people. I’ll make excuses for them. Forgive them wholeheartedly because of their limitations and that they, like me, are on a journey and we are not all meant to learn lessons at the same times through our lives. I struggle to understand doctors. I wonder if they really care, why they chose their profession, if they are real human beings. I wonder a lot because yes, I have experienced so many wounds. I forgive (never forget) and move on. I begrudgingly go to my appointments, spill my guts and show my most intimate parts to people I barely know and wouldn’t trust with my car. But, yes, I will allow them to do these things with me because I have faith in medicine. I feel trapped in this system, without options or choices. I feel victimized, raped and disgusted with my body and not because I look at it in the mirror but because I’ve been told I’m fat, been mistreated, ignored and put in my place by my doctor. My mind tells me, I don’t have to take this. I don’t have to go to the doctor and I can just rot away because they don’t deserve the privilege to treat or know me. They don’t even care if I am alive anyway. I am free and beautiful, and will not allow myself to be tainted. Then, the pain starts and what else do I do. I have a family, friends…I owe it to them to stay alive. So, begrudgingly, I return to this doctor who I have no respect for and tell them my secrets, knowing they will write it down for all the office to see and discuss with their friends, because my life is more important then my dignity. Then, I forgive my doctor again and the process of getting angry comes around again. I just want to believe in good. I want to believe we’re all valuable and cherished but it’s not easy.

We need a change…if not for ourselves, but for our children. This is the only way

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