Saying “I do” to patients

I was recently on a panel discussing Me Too in medicine at the Medical Women’s International Association Centenary meeting in Brooklyn.  A female cardiologist who has been seeing a male patient for the past 20 years (he is now in his mid 80s) shared her predicament. Until recently he was well behaved and understood the boundaries of their relationship. Now he is developing early stage dementia and acting inappropriately.  This manifested as sexually suggestive speech during a consultation.  She was seeking advice about how to handle the situation.

Caring for our patients over long periods of time is like a therapeutic marriage.

There was a of plethora of suggestions for the cardiologist from the panel and the audience.  For example, deal with each condition sequentially. Or, in response to his dementia, “Say nothing and just make sure you have a chaperone in the room with you whenever you see him.”  Another suggestion was to “try to reason with him and explain how his behavior is becoming inappropriate.” Finally, one exasperated recommendation was to “explain that you can no longer treat him and arrange for him to see a male cardiology colleague.”

A doctor-patient counsellor could help.

All the responses had some thought behind them and a genuine concern to help the colleague resolve the situation expediently. Unfortunately, our solutions are not always patient centered, especially when it comes to patient-initiated sexual harassment. Like with a marriage going wrong, an intervention by a third party, a kind of doctor-patient guidance counsellor, could help.

When we care for our patients over long periods of time it is like a therapeutic marriage. Initially, there is a honeymoon. We can do nothing wrong.  Our patients, relatively unknown to us, come to see us with problems. We are expected to catalyze some change in them for the better, after we take a history, do a physical exam, order some tests, give them a diagnosis or prescribe some treatment, and then separate.

But over a number of consultations, the relationship deepens. It is a two-way street where both participants have to listen and learn and change together to get an effective result. As in a marriage, however, the doctor-patient relationship can get stuck.

 

In this case, where the patient’s cognitive state is deteriorating, and his physical state remains satisfactorily managed by this clinician, something has changed in the relationship and before it is too late, some intervention has to occur. Depending on the stage of dementia, a consultation with a third-party counsellor might help.  Unfortunately, as yet, such interventions have not been adopted and we lack any therapeutic guidance counsellors to intervene.

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