Social Contract

I see patients. Patients come to be seen.

 

I see patients to deal with their perceived problems. I often ask patients, “What would you like me to do for you?” and many times they answer, “I don’t know.” Sometimes, I deal with problems that patients do not perceive, that I believe have to be dealt with. In those latter circumstances patients can usually be persuaded to let me solve the problem I see.

 

I am not invested in a course of action or an outcome. I am invested in the process. So, I don’t have intrapsychic difficulty with patients who won’t let me solve a problem they haven’t presented with (incidental problems).

 

I have a problem-solving orientation. It is perhaps a default male position: we expect to fix things. It is nevertheless a reasonable ED orientation: we find and fix problems. And that is the reason that patients present to us, but not all problems can be defined nor can all defined problems be fixed.

 

That adults present with problems they should know cannot be defined or fixed is something that puzzles me no end. Do they present in the hope that their assessment is wrong or do they present…?

 

Adults do have a highly developed sense of the impossible. They do not seem to have an equally developed sense of the possible. I am not being facetious: the one does not imply the other.

 

When terminal patients present because they fear dying they violate fundamentally our social contract. It is reasonable and human and expected that one fear one’s death. It is a rape to expect a stranger with an impotent fiduciary responsibility to deal with that fear. As clinicians we remain humans in our interactions with those humans who present to us as patients: our humanity leaves us open to emotional contagion. And I find such emotional contagion more tiring, more draining, than extreme physical labour.