“So how is our friend, Anne, today?”
Immediately, my mind struggles with anxiety. I run thought the litany of options, “She’s ok.” “I don’t know.” “I can’t answer that question.” “I’m not sure.” …. I return the friendly smile as I ponder the question, and I say jokingly, “I’m not sure. We’ll have to ask her.”
It’s pretty normal to talk about the friends that you have in common, but when the “friends” are also your patient. The information falls under the medical privacy laws, and some of that information has legal protection.
“If you ever see me in public, I’m going to pretend not to know you unless you approach me,” said a psychiatrist to her new patient at the end of the meeting. I was a doctor-in-training observing the interaction, and I was just beginning to realize how complicated it is to navigate relationships with patients outside of the office. When I worked with doctors in small towns, I realized that the anonymity of the large city is sometimes a blessing. What is just “normal conversation” for some people is not just unethical, but sometimes illegal, for doctors.
When I began to explore the stories of medical school and residency, I realized that they were hidden in a special compartment of my brain. Medical privacy laws had created an area of experience that I did not talk about, did not write about, did not even enter to think about again. Sometimes it was just easier to not talk about it, rather than try to figure out which parts are ok to talk about in social situations. Between medical colleagues, we share the information necessary to take care of the patient. That is a different form of communication. “How is Mr. X?” has a whole different connotation and requires a different answer when “Mr. X” is a mutual patient in the hospital.
Doctors often publish case studies by changing names and judiciously removing information that might identify the patient. We give an objective medical history of the patient that also removes our own emotions that are stirred up and our own subjective experience. The practice of telling our own personal doctor stories is rare. There are not many forums to do this when we leave medical training. With unprocessed stories locked inside, stressful work hours, and no one to talk to, the practice of medicine can lead to burn out, depression, anxiety, or worse.
Reflecting on the Past
As I reflect back on my medical training, the memories are now faded. However, the emotions and beliefs are still there. As I begin to express those stories in writing or tell those stories to others, I consciously fictionalize identifiable information. In some cases, the memory has faded enough for me to just make up the details or combine multiple patient experiences into one fictional patient story. I let go of the strict conventions required by the medical chart, and I enter the freedom of narrative expression. The memories, emotions, feelings, beliefs are all true, but the expression shifts from objective truth to subjective truth. I struggle to make meaning of these memories in the context of my life and perspective today. I struggle to give them universal meaning that is worth expressing to a general audience.
In medical training today, more and more programs are recognizing the power of writing, communication skills, and storytelling to create better mental health for doctors and other health care workers. When we can share the emotionally vulnerable moments of our life and find a place to listen and be listened to with compassion, we can reconnect to meaning in our life and feel less alone in the world. We can access more resilience, empathy, and connection with others. We can improve our mental, emotional, and overall wellbeing. We can be healthy health care workers.