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  • Doctor Talk To Me

    A great essay by Anatole Broyard.
    "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

  • #2
    Jon,

    Great essay. This should be posted in every department and staff meetings should revolve around its implications.

    Somehow Broyard conveys the manner someone in which a caregiver can make us aware of their true passion for thier work, and not themselves.

    I was asked last week if my patients all "loved" me as I treated someone in front of the class. I responded that this certainly wasn't the case and that, in my opinion, encouraging that sort of attitude wasn't even therapeutic. The woman who asked disagreed. She said that she got all sorts of gifts at the holidays from patients expressing that love for her. Ugh.

    I will concede that if you were to compare our personalities there are those who would find her's more engaging, but there was no evidence that she actually knew what was going on inside her patients. She remained on the surface and seemed satisfied with what she imagined their appearance and cookie baking implied about her "therapy."

    She's not alone in her assessment of therapeutic presence, not by a long shot.
    Barrett L. Dorko

    Comment


    • #3
      The giving of gifts to practitioners suggests the therapeutic relationship has never gone any 'deeper' than a symbolic or superficial level. When it does, people learn the existence of new levels of themselves. They figure that's what they've paid for, and they leave it at that. They don't bother sending cookies, instead they send new patients.
      Diane
      www.dermoneuromodulation.com
      SensibleSolutionsPhysiotherapy
      HumanAntiGravitySuit blog
      Neurotonics PT Teamblog
      Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
      Canadian Physiotherapy Association Pain Science Division Facebook page
      @PainPhysiosCan
      WCPT PhysiotherapyPainNetwork on Facebook
      @WCPTPTPN
      Neuroscience and Pain Science for Manual PTs Facebook page

      @dfjpt
      SomaSimple on Facebook
      @somasimple

      "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

      “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

      “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

      "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

      "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

      Comment


      • #4
        One of Wes's parting acts at our hospital was to hang up "Asking Why", "The Use of Simple Contact", and "Adaptive Potential." They seem to be in the identical position today as the day he hung them up. I'll retire them for now and replace it with this essay.

        Nice try Wes.
        "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

        Comment


        • #5
          Jon,

          Thanks for the "shout-out". Great link. Even though I no longer have you throwing 3-4 articles per week on my desk, you still continue to amaze me with your ability to find all of these great links. Keep up the great work.

          It's encouraging to read something like this from someone who seems to have great "self-awareness". It's a shame that more people (patients and providers alike), aren't able to examine themselves and their roles as well as this author.

          Even though I am no longer at the clinic with you, I still feel an immeasurable sense of debt and gratitude to you for helping shape my approach to patients, and myself. It was a "bitter pill" to swallow, but the side effects have been wonderful.

          Barrett and Diane,

          Your points could not be any more poignant and true. Your continued insights and contributions are reaching this "n of one".

          Wes

          Comment


          • #6
            I just realized that I've become "that guy", who uses these things (" "). Can anyone help me with that? Yikes.

            Wes

            Comment


            • #7
              Wes, don't worry about using ""s. It indicates a yearning to become more clear - that is all. It is in no way a symptom of anything even remotely pathological.
              Diane
              www.dermoneuromodulation.com
              SensibleSolutionsPhysiotherapy
              HumanAntiGravitySuit blog
              Neurotonics PT Teamblog
              Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
              Canadian Physiotherapy Association Pain Science Division Facebook page
              @PainPhysiosCan
              WCPT PhysiotherapyPainNetwork on Facebook
              @WCPTPTPN
              Neuroscience and Pain Science for Manual PTs Facebook page

              @dfjpt
              SomaSimple on Facebook
              @somasimple

              "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

              “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

              “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

              "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

              "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

              Comment


              • #8
                Whew. :thumbs_up

                Comment


                • #9
                  By the way Jon, I sent this essay to a friend of mine who is currently dealing with a bit of cancer herself. Thanks for posting it.
                  Last edited by Diane; 09-04-2007, 01:56 AM.
                  Diane
                  www.dermoneuromodulation.com
                  SensibleSolutionsPhysiotherapy
                  HumanAntiGravitySuit blog
                  Neurotonics PT Teamblog
                  Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                  Canadian Physiotherapy Association Pain Science Division Facebook page
                  @PainPhysiosCan
                  WCPT PhysiotherapyPainNetwork on Facebook
                  @WCPTPTPN
                  Neuroscience and Pain Science for Manual PTs Facebook page

                  @dfjpt
                  SomaSimple on Facebook
                  @somasimple

                  "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                  “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                  “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                  "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                  "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                  Comment


                  • #10
                    You're welcome Diane. Later tonight I'll post some more from Anatole per David Morris.

                    Give her my regards.
                    "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                    Comment


                    • #11
                      I can't access the essay at work, however, if I may be so bold, would like to comment a bit about patient's "loving" therapists. I'm sure this is to blow off steam after losing some patient's while I was away back in Wisconsin for 6 days. The benefit of working in a facility hell bent on doing stuff but employing a technique that involves doing nothing is being able to sit back and observe other "successful" therapists in action. This is what I observe:

                      If you want praise and gifts from patients it seems best to validate them and give them what they expect... oh yeah, and find lots of things wrong with them. Nothing creates a bond better than having a lot of problems and a common goal endorsed by the culture. The more effort you apply to the problems the better you seem to be received. Do not make things look easy, everyone knows it takes effort to get better (also it appears as if they are getting their money's worth). Read health magazine covers in the grocery line and use those buzz words while informing the patients about their condition and care. As long as treatments align with those ideas you will be liked. Your patient may not get better, but for some reason, they will love you and bake cookies. If all else fails just look like everyone's grandson (this may not work for all of you, but for the right population and therapist this can be a cookie goldmine). I fortunately happen to have this last skill and since I lost my "cookie maker" on Tuesday to cancer, I may just have to put this into practice.

                      But seriously, I always run the risk of not being popular to some patients by employing non-traditional but sensible care. I feel that in some groups, the space I give to catalyze patients ideomotion is met by fear and loathing. It's like they don't know what to do when someone isn't present telling them how to be/act. All will move toward correction and get better, but I seems that if the discomfort of having to rely on their own instincts for a change is greater than their improvement, I lose them to someone who will tell them how to behave and validate their problems instead of solutions. At least that's what I tell myself these days. This used to disturb me, but now I allow myself a 10 second fit and get over it. It's too uncomfortable to go the other way. Curses!

                      Chris
                      Last edited by christophb; 06-04-2007, 01:10 AM.
                      Christopher Bryhan MPT

                      "You are more likely to learn something by finding surprises in your own behavior then by hearing surprising facts about people in general"
                      Daniel Kahneman - Thinking Fast and Slow

                      Comment


                      • #12
                        Hilarious post Chris, likely true. The only way to have "our" kind of work shine seems to be, go get your own practice and let the right people find you, i.e., the ones who are serious about freeing themselves of pain.
                        Diane
                        www.dermoneuromodulation.com
                        SensibleSolutionsPhysiotherapy
                        HumanAntiGravitySuit blog
                        Neurotonics PT Teamblog
                        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                        Canadian Physiotherapy Association Pain Science Division Facebook page
                        @PainPhysiosCan
                        WCPT PhysiotherapyPainNetwork on Facebook
                        @WCPTPTPN
                        Neuroscience and Pain Science for Manual PTs Facebook page

                        @dfjpt
                        SomaSimple on Facebook
                        @somasimple

                        "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                        “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                        “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                        "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                        "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                        Comment


                        • #13
                          From David Morris's, Illness And Culture In The Postmodern Age(p.47)

                          Sexuality has only a minor place, if any, in the biomedical account of illness, but Broyard creates a counternarrative in which health and sex are closely linked. "My urologist, who is quite famous," he begins, in another of his sly openings that set us up for a surprise, "wanted to cut off my testicles..." He continues, "[b]ut I felt that this would be losing the battle right at the beginning. Speaking as a surgeon, he said that was the surest, quickest, neatest solution. Too neat, I said, picturing myself with no balls. I knew that such a solution would depress me, and I was sure that depression is bad medicine". The narrative that Broyard composes is no exercise in wishful thinking or literary distraction. He shapes his medical treatment to the story he constructs of a defiant jester-hero who proceeds through illness with his full power and integrity undiminished....
                          ....The doctor's preference for the surest, quickest, neatest solution does not necessarily create the best story, from a patient's point of view. Broyard's verbal prowess is retelling the vignette about his rescued testicles gives him the upper hand over the fabled urologist, whose "solution" is exposed as therapeutically inept, even if surgically indicated.
                          Buy the book. It's full of brilliant prose.
                          Last edited by Jon Newman; 06-04-2007, 05:48 AM.
                          "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                          Comment


                          • #14
                            Chris, having avoided private practice assiduously for a couple of decades, I know exactly what you mean. It is perfectly accurate for a high percentage of patients in the public system.

                            It's ingrained in people to go to a physio so s/he can tell them what to do and how to do it; and PTs usually expect to tell someone how to do this or that.
                            People go to social workers, psychs to be told of strategies to use and for a shoulder to cry on. People go to docs to be told what meds to take and what the prognosis is.
                            I don't know for sure what's chicken and egg, but suspect it all started with the health professionals, "knowing more than the people do". Such as the many docs who tell their patients with ongoing pain that they will have to accept it and live with it; hidden there is the message: I don't know what is wrong with you".

                            As for cookies (biscuits in Oz!) and other gifts, I find that patients seem to appreciate the best social groomers - those who chat, smile and establish rapport and those who struggle to find everything (wrong or not)and give them lots of attention, even if there is not much rapport.

                            I know a lot of people who keep going to the same PT, year after year. When asked how things have changed over time, the usual reply is that nothing has changed, but could be worse if attendance ceases. That says a lot.


                            Nari

                            Comment


                            • #15
                              The use of force by William Carlos Williams
                              "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

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