Relationships Rupture
Relationships Rupture.
It’s the Repair that Matters.
The patient just did something outrageous. I’m mad. I feel attacked. I don’t want to see this patient again, but I have to.
Sound familiar?
When we get a history from a patient, we are getting their side of the story. We hear their version of what things are like, with their family or boss or colleagues. We get their version of the illness or injury. And we certainly get their version of how other providers have not measured up. We may look at their records and wonder how this or that was missed, or not tried.
Then comes the event. Whatever it is. The blow up. The crisis. The adverse effect.
What are we seeing? Is it really about us?
Sometimes it is. We make mistakes. We don’t give them informed consent. We missed the part about a particular med causing a particular reaction.
Often though, what I am learning to trust is that the crisis brings to light important clinical information. I may have just learned why family members are not more involved, or what psychopathology is at work. I may have learned that I remind the patient of a father, a boss, a male figure who was hurtful to her. It may be that I have just learned of a personal crisis or a financial one that the patient had not disclosed.
No matter what, I am learning something about how the patient reacts to pain or stress or crisis. It’s valuable information. When we take it personally, we miss the message. We also miss the opportunity to go deeper and see if we are actually addressing the most pressing problem. At the very least, we miss learning how a patient is, because in our minds “they shouldn’t be that way.”
Okay, So It’s Valuable Clinical Data…
What Now?
What to do about the relationship rupture? One of my teachers used to say “the rupture is not as important as the repair.” Think about it. Every time a mother walks away from baby, there is a rupture. What matters is that she comes back, and it is a good reunion. The baby learns to trust that the rupture is temporary, and the relationship can be trusted. When we have arguments with our spouses and children, the repair is what matters. It teaches us that the relationship transcends the momentary break.
Data is Discovery – About the Patient, and About You.
Trust the Process.
Relationships with patients rupture. We can’t be perfect. Sometimes what we think communicates or comforts, just doesn’t. The rupture tells us something important about the patient – just like a fever spike, or a change in WBCs. Something is going on. We need to find out what it is, in a non-threatening way. Our patient has just given us a clue that something is important. Let’s find out what it is, and trust that process. It’s valuable clinical data – and no matter what they say, it is not necessarily or exclusively personal to you. But you can learn and grow from it, professionally and personally.
Peace,
Tony