Doctors, Ordered

Posted by fxckfeelings on January 11, 2010

We’ve often made the point that shrinks are doctors, not magicians, but we got a couple of cases this week take that point even further; not only aren’t shrinks magicians, they’re also people (and it turns out that surgeons are doctors and people, but really don’t want to be confused with shrinks). Not surprisingly, even doctors need a doctor once in a while, even if it’s an e-MD…with no magical powers.
–Dr. Lastname

I’m a therapist who takes great pride in being available and supportive to my patients, but I’ve got one who’s driving me crazy. At first, he thought I was great at helping him get more confident and functional, but lately he’s been slipping and drinking too much and fighting with his wife, and, instead of seeing me as a supporter who wants to help him control behavior that’s hurting him, he blames me for giving bad advice and being critical. I asked if he’d like to see a different therapist but he said he wants me to apologize and listen to him more carefully so I can make up for the pain I’ve caused. I’ve listened, and all he does is give me an endless earful about how badly I and other people have treated him and how I’ve made him feel worse, not better. I want to refer him elsewhere, but I can’t, because I wouldn’t wish this guy on my worst enemy but I can’t abandon him, and I don’t want to get sued or burn any bridges in what’s a pretty small professional community in this area. My goal is to get rid of this guy without feeling like I’ve abandoned him or triggering a malpractice suit.

If your goal as a therapist is to make people feel better, then it’s no wonder you’re fucked; as such, you’ll have no defense against the kind of asshole who feels you (or really, anyone but them) is responsible for their happiness and pain (mostly pain) and therefore deserves punishment when things go bad.

Under your rational exterior, you seem to agree that you’re responsible, Dr. Feelgood, so he’s got you, and he knows you speak his language. Asshole 1, Therapist 0.

There’s nothing wrong with being supportive, but what’s toxic is sounding responsible for his happiness, and then acting defensively when he accuses you of ruining his life. Sounding guilty when an asshole whines at you is like waving a red flag in front of a bull or showing fear in front of a lion.

Certainly, he hurts a lot, in both the active and passive sense, and truly wants relief. When initially he felt better, however, and told you that your good treatment was responsible, he also meant that he now knew whom to call when things went bad.

You probably said something modest and supportive like “Gee, that’s nice, but you should credit yourself with doing a better job of managing your feelings.” Then treated yourself to extra cake after dinner for a job well done.

What you should have said, in retrospect, is, “feeling better is great, but what really counts is how you manage your behavior when you don’t feel so hot, which we know is bound to happen sooner or later.” Alas, it’s at times like this that we all wish we were magicians, or could at least travel through time.

The sad fact of life is that, if he’s a perfect asshole, nobody can make him feel better, not a fellow therapist like you or a common civilian, and giving him an opportunity to make you feel guilty offers his inner demon a Happy Meal.

Remember, you’re professionally responsible for easing his pain if there’s a way to do it. Otherwise, you may feel terrible, helpless, and irrationally guilty, but your only responsibility is to let him know, politely, that you can’t help him, and you will be most helpful at that time if your demeanor indicates sadness but absolutely no sense of guilt or blame.

You should be clear that there is no hope, none, ever, about your ability to ease his pain, but that there is definite hope that he will eventually feel better if he can gain better control over his behavior.

He might not want this hear you on this, or might not be able to because he’s cursing at you, but either way, in this confrontation with an asshole, you’ve done your best as a doctor or just a mere mortal. At that point, you can treat yourself to extra cake after dinner, and hope he doesn’t sue.

STATEMENT:
Prepare a statement that addresses him and your own, no-boundaries sense of responsibility. “I would very much like to help you feel better and gain more control over the behaviors that are messing up your life and I regret your feeling that my contribution has been negative and destructive. In my opinion, the problem isn’t bad treatment, it’s that no treatment has yet been invented that relieves the kind of pain you’ve got. Sorry. When something hurts you, it’s so overwhelming you lose your perspective and do things, like drinking and arguing, that make it worse. That’s simply the way your brain works. But if you ever think you can control your behavior when that kind of feeling comes over you, then there are lots of treatments that can help your control, and eventually, control can make you feel better. Meanwhile, I’m firing myself from your case because your negative feelings about me distract you from thinking positively about your own needs. Think about what you need, and, if you want to focus more on changing your behavior, I’ll be happy to give you recommendations and referrals to other treatments.”

Like you, I’m a doctor, but unlike you, I’m a surgeon, and as you probably know, surgeons aren’t really interested in chit-chat when it comes to patients; we do our best work when patients are heavily sedated and have nothing to say. My issue is that patients come into my office dying to open up to me, even though the only problems I’m willing or qualified to help them with involve the use of a scalpel, and I’d like to help them because I believe in being compassionate, but talking isn’t my thing. (They might think I’m verbal because I’m one of those rare female surgeons, but guess what, being a woman doesn’t make me Oprah, I’m still an MD.) Anyway, since you have to hear people’s problems for a living, I was wondering if you knew a polite way to get out of hearing those problems without hurting their feelings or failing them in any important way. My goal is to get my patients to shut up, without sedation and without guilt.

If being a good doctor required you to be sensitive, compassionate, and eager to listen to people’s feelings, then there’d be no room for men in the profession other than for lifting heavy tumors. Sorry, Oprah.

Fortunately, however, there are good ways for the non-verbal, the verbally challenged, Aspbergers sufferers, “dudes,” and cowboys of all kinds to do right by their verbally articulate/needy friends, clients, and spouses.

You’re off to a good beginning because you’re not trying to change yourself into someone you’re not; imagine Richard Nixon or Bob Dole attending a sensitivity training group. Thank goodness you don’t feel that’s your job.

Trying to be sensitive when it’s not your nature will undermine your self-confidence and get your knife to slip, so don’t do it. You show no sign of shame, so I don’t need to tell you to attend Cowboy Pride meetings.

The important thing is that, sensitive or not, you treat your patients decently and meet your own standards for attending to their needs. You can do this by taking time to answer all their questions and by teaming up with someone, a nurse or social worker, who’s good at listening and responding to their feelings.

Nurses and social workers often need to team up with someone who’s good at non-emotional logic and procedures, and vice versa. We’re all retarded in one way or another and need to know our weaknesses so we can manage them well.

You’ve got no shame or false pride, so you’re ready to do what you need to. You handle the knife, let a nurse or social worker do the emotional heavy lifting. Yeehaw.

STATEMENT:
Here’s a statement that’s polite and meets moral standards. “The demands of my surgical activities do not always allow me to meet my patients’ emotional needs as well as I would wish, so I urge patients to bring me all their factual questions about surgery, recovery, and possible complications, and to schedule time with other members of my clinical team to address their feelings about these issues.”