Tuesday, December 29, 2009

Jennifer Frank, MD: Intimacy

I am both amazed and humbled by what patients share with me. They volunteer the most intimate details of their lives and allow me to examine the most intimate parts of their bodies. I hear things that no spouse, parent, counselor, or priest hears. Something about the trust patients place in their doctors and a desire to share important information motivates patients to reveal these intimate details.

The knowledge I have about my patients is sacred. Indeed it is so sacred, that I have both taken an oath to protect it and am under strict legal obligation to safeguard it.

I was pondering this recently as I chatted with our housecleaner in my kitchen one morning before I left for work. She enters our lives and our home every other Monday morning. She arrives early, when we are still in our pajamas, and vacuums around us as we eat breakfast, get ready for work and school, and handle the inevitable morning meltdown (usually one of the kids, but occasionally one of the parents). It is hard to hide your true self from someone who vacuums under your refrigerator and cleans your toilet bowl.
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In many ways, the relationship I have with my housecleaner is even more intimate than the one I share with my doctor. I tell my doctor that I eat healthy, but my housecleaner sees me eat a chocolate chip cookie for breakfast. When asked about my stress level, I tell my doctor that I am doing fine. My housecleaner sees the difficulty I have balancing the multiple demands made by four young children. She sees the inner workings of my family, what books are on my bedside table, the food we eat, how tired we are.

I often wonder what she thinks about us. Is she as horrified as I am that it took her seven hours to clean our windows this past spring or is that “normal”? Does she silently judge the way we parent our children? How do we compare to other families in trying to get everyone out of the house in the morning?

My patients must feel similarly. Do they sense that I am perfectly accustomed to the “oh, by the way” symptom of erectile dysfunction offered at the conclusion of a visit? Do they perceive me judging them for failing to take their diabetes medication? Are they concerned that I may discover too much or pick up on secrets they wish to keep hidden? It reminds me of the unique vulnerability patients experience.

I also realize how limited my vision is. Sure, I can ask (and have asked) almost every question imaginable, including some that probably made me blush. But, 15 minutes is hardly a window into someone’s life. How much different it would be if I could get the “housecleaner” view of my patients’ lives. I can ask those probing questions that allow me to visualize what I can’t see. What did you have for breakfast this morning? What time do you go to bed? Who lives in your home? Hopefully, this will fill in the gaps that are not revealed, so that I can get a sense of the whole person and hear beyond their words.

Jennifer Frank, MD, FAAFP, is an assistant professor in the University of Wisconsin Department of Family Medicine and a faculty family physician at the Fox Valley Family Medicine Residency Program in Appleton, Wis. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.

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