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Walking the Tightrope With medicine, as with most other high-impact professions in the world, there is a balancing act continuously in the works. There is an interplay of seemingly opposing forces: compassion, professional detachment, authority, kindness, patience, urging the other party to adhere to the regimen-being accessible while maintaining and air of utter respectability. Sure, Doc, good luck with that. It is impossible, paradoxical and it is our job, plain and simple. The urge to quit the act, to throw down the tottering bar and become cynical, or effusive, as a failsafe, is weighty. It would be all too easy to say, "I stand at THIS discrete distance from the patient, always. No matter who they are, or what their circumstances may be, I am this far removed. No more, no less.” There are plenty of physicians that have chosen this stable vantage point. It may even be the safer emotional choice for the practitioner. Having tried that tactic for years, I found that it didn't suit me as person or as a medical practitioner to have a default setting in relation to medical professionalism. Each person, and therefore each patient, is different. I would rather learn about the patient, their lives and their circumstances, dynamically, and then choose a mode of operation, then to assume one demeanor and apply it to all. It's a more challenging undertaking. Hopefully, at the end of the day, it will be a more satisfying one, both for me and the patient. Skills like active listening, asking open questions, adjusting demeanor and establishing professional boundaries take years to develop, even without adding in extra ingredients like compassion. This is why I value the opportunity to go into the field with HSO. In the context of home visits to the house-bound, we are going to the patient in their homes. It is a very different circumstance than we will be facing in hospitals and in private practices, where the patients will come to us. They will have appointments. They will leave their families behind, for the most part. Their pets and their possessions, too, will not be joining them on their trips to the doctor's suite. The food they eat, the kitchens they cook the food in-all those elements of the patients' lives will remain at a discrete distance from us. All most of us will ever have is the patient, removed from their context, sitting on the same tables all our patients sit on, telling us about their lives. With HSO, the opportunity is to step into the context of the patient, to temporarily become a part of their lives, and ask them questions as they sit on their couches while their grandchild watches cartoons. The picture one can get of a human being in their own context is very different than the one a few words can paint while sitting in a semi-anonymous office. Every time HSO goes out to see patients, as we walk into their living rooms, or sit with them on their porches, I am struck by the dignity and the humanity of the circumstances. We are two people-one of whom has medical issues they want to discuss, the other of whom wants to listen and try to understand. We are more than that as well. It's a balance. I am not perfect at maintaining it. With every attempt, though, I feel as though the feat is more possible, less outlandish, more polished, more graceful, less clumsy, more intuitive. In many ways, here in the midst of our training, the best that we can do for the members of the community is listening with genuine concern and deference. After our training is formally complete, what will be the best that we will be able to do for our patients? It will be very much the same, I suspect. Take the knowledge we have in one hand, the desire to help in the other, wade out and wait to see what manifests between one person and the other. Formality, with the willingness to shift the balance as needed. So that we are always two people, even if we aren't at the moment on a porch. So that the TV with the cartoons is on just out of audible range. The kids are playing somewhere out of view. The patient is in the context of their life, as much as possible inside the confines of an office, or a hospital. I, the juggling doctor, also get to be a human being, in so far as the confines of my white coat allow me. Teeter. Totter. Balance. Voilá. ~
SGU SOM student and HSO member
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