There has been much written about the doctor-patient relationship, and specifically how to best maintain a clinical distance while at the same time being empathic and compassionate. This is something individual doctors work on throughout their careers, but something else interests me here.
Most physicians derive enjoyment from helping people. Altruism (a topic way too complex for me to pretend to understand in depth) feels good both from the act itself and from the response one gets from the object of the altruism. This last bit has comes with potential pitfalls.
My job is to help people. If they express appreciation for this, well, that’s a nice perq, but I cannot and should not rely on this. When we count on our patients to validate our good feelings about ourselves, we are engaging in psychologically complicated behavior that is not entirely consistent with some basic principles of medical ethics.
As with all ethical problems, an example is much better than an abstract discussion.
Let’s say that, as part of my board recertification process, I am asked to gather data from patients and colleagues on my performance as a physician. I may feel awkward asking my patients to “grade” me, but should I anyway?
That all depends on how I ask. If I tell them truthfully that their feedback is confidential and the data, if returned to me at all, is sufficiently vague as to make responses difficult to trace, and if I ask them to be honest and direct with their grading, then it seems fairly neutral ethically, in that there is little downside for the patient. Additionally, helping the board certification helps the patient directly and indirectly by winnowing out docs who don’t make the cut, including their own.
If, however, I ask my patients either implicitly or explicitly to support me, I have put my own needs above theirs. The act of evaluating or supporting me should be entirely voluntary and should not involve coercion. Cui bono? If the purpose of my asking is to benefit myself first, then there is no reason to ask my patients to do this. There is no advancement of the ethical goal of beneficence, and the patient may in fact feel coerced.
If a patient wants to say nice things about me, that’s great, but there are some very messy ethical issues involved here and some very narrow lines to toe.