Healing The Doctor-Patient Relationship, Part 2
In Healing The Doctor-Patient Relationship , I wrote about the traumas that can happen for both patient and doctor, when the doctor-patient relationship is a patriarchal, hierarchical “power over” structure. But what’s the alternative? How else might we consider relating to patients or showing up as the patient? Let me suggest a different kind of doctor-patient relationship, an antidote to the patriarchal hierarchy, if you will. When I was seeing patients in my integrative medicine practice, this is the contract I asked them to sign. If I become a patient forced to interact with the medical system, as we all are likely to have to do one day, this is the kind of agreement I would want to have with my practitioners.
A Sacred Doctor-Patient Contract
As doctor and patient, you and I are entering into a partnership. I will not give you orders because we will be collaborating, and your voice is as important as mine, if not more so. Because we will be partners, I feel it is important to clarify and agree upon what our relationship will entail, what you can expect of me, and what I expect of you. I am here to support you, guide you, offer you tools, and support your process, but I will not “fix” you — for I don’t believe you are broken. Although I am trained as an expert to deliver certain medical treatments that might save your life, I do not have more authority over your body than you do and I cannot heal you. Only you can do that. Just like I might set a fracture in a cast but only your body can heal the broken bone, I can give you drugs or do surgery to help you get better, but only you can actually heal your body. To accomplish this massive goal of healing, your nervous system will need to be in the rest-and-restore, tend-and-befriend ventral vagal parasympathetic state. If I am activating your stress responses, I am doing the opposite of helping you heal and you have a right to protect your nervous system. I will not always get this right, since I am so stressed out myself by the moral injury of cooperating with a corrupt health care system that gives lip service to patient wellbeing while being ultimately at the mercy of the financial bottom line. But I vow to do my best to be a healing presence, so your self-healing mechanisms can activate. Although I will support you in every way I can by educating you, giving you choices, answering your questions, making recommendations, and implementing treatments you choose without coercion, you must do the heavy lifting of healing yourself. If you are not ready, willing, or able to be an active participant in self-healing, if you would prefer to stay in the patriarchal model, where you give all your power away to me and I alone bear the responsibility of curing you, I will still be here to nurture and support you, but the process will be less powerful, with less optimal results than if we enter into this relationship as healing partners. Although I spent many years training to earn the right to be your doctor, I am not “better” than you, and as such, I will treat you as a cherished equal. In order for our partnership to be successful, we must- absolutely must- respect each other. You will not put me on a pedestal, and I will not look down upon you. I will speak to you when we are both dressed and only leave you naked in the brief moments when I need to examine you. I will respect your privacy, honor your modesty, and invite you to put your clothes back on as soon as I’ve done what I need to do. I accept that my time is not more valuable than yours. As doctor and patient, we will respect each other’s time. I will not make you wait for your appointment, and you will not be late. We must be present, as fully and completely as is possible, during our time together. I know electronic medical records make this hard, but we will do our best to turn off cell phones, avoid distractions, and focus all of our energy on your health and healing. I will call upon my knowledge, experience, and resources to offer you recommendations for preventative care, diagnostic workups, and treatment plans, but I will also invite you to listen to the intuition of your healing inner wisdom, your body, and your wise Self. I will explain why I make the recommendations I do, but I will always respect your autonomy, without judgment. If you choose not to follow my medical advice, we will negotiate another plan that resonates with your intuition. If I am unable to provide the care you need or desire, I will release you to follow your heart or find another provider without taking it personally or labeling you as “non-compliant.” In return, I hope you will understand if our current medical-legal climate makes me cover my ass sometimes, and you won’t take it personally. Ultimately, the choices for how we proceed will always be yours, whether I agree with the plan or not. You are always welcome to challenge me, question me, or be the expert of your own illness without needing to worry that you’ll offend me or cause narcissistic injury. I vow not to take your empowered self-interest personally. In exchange, I ask that you do your best to follow through on any treatment plan we do agree upon, making sure all your “parts” are on board and that you’re not just appeasing me and then rebelling. If our treatment plan does not resonate with your body’s wisdom, or if you have financial constraints, please tell me so that we can modify our plan. Follow through is key. We must walk this path together in order to optimize your health outcome. I promise to be optimistic about your capacity to heal from illness, trauma, or loss, without offering you ungrounded false hope. I will never view you as hopeless or broken, and I will hold sacred space for the whole, perfect, healed individual I know you to be, even in the midst of ill health. I will tell it to you straight so you understand science and statistics, but I will never tell you hope is gone, because I cannot ever know the future, and spontaneous remissions do happen mysteriously and unexpectedly. We have to be open and tell the truth, even if it is painful or uncomfortable. I will promise you confidentiality, and you must promise me to tell me anything I need to know in order to provide the best medical care possible, including a complete trauma history. We must trust that we are safe together, so we can explore things that may be tough to explore. We must open our hearts to the loving kindness and compassion that is a necessary part of any healing relationship. As my patient, you will understand that I am a mere mortal, prone to mistakes, flaws, insecurities, ego, fatigue, tears, and distractions in my personal life. You will not put me on a pedestal, and you will cut me some slack if I’m less than perfect, just as I will do with you. If I let you down, you will tell me gently, rather than bottling it up and storing it as resentment or exploding and attacking. In return, I will share with you how I feel about our relationship. If at any point, one of us cannot meet the other’s needs, we are free to dissolve this relationship at any time with loving kindness and compassion. As doctor and patient, we agree to accept that we’re both doing the best we can at any given time, and we won’t always get it right. We commit to open communication, mutual respect, a belief in the infinite capacity for whole health and healing, and a dedication to cherishing the process and viewing health issues as an opportunity to heal deeper wounds, in addition to the physical body. Are you on board? If so, sign here.
One Patient’s Response
I showed what I’d written to a friend who was undergoing cancer treatment, and she cried and said “Don’t give me false hope that something like this could be possible.” She said she found it easier to just accept that her doctors were mostly rude, narcissistic, entitled, and controlling- and avoid trying to fight reality with a desire for more equality and respect. But when I said “What if? What if it was possible? How can we change the system if we can’t even dream of what’s possible?” she said “Bring it on.”
One Doctor’s Response
I showed this agreement to a doctor I respect, who has a big, open heart and genuinely cares about his patients. I could see his chest rise and fall as he read it, and when he finished, he looked up at me with great big puppy eyes and said, “Lissa, I love it. But I don’t trust that I could do this. I’d want to. But could I? I’d hate to promise something I couldn’t actually follow through on.”
I asked if he wanted a copy so he could give it to his patients. He hesitated, furrowed his brow, looked down at the floor, tapped his pen on his knee, looked at me again before averting my eyes, and said, “No. Thank you, but no. I’m not ready yet, but maybe some day I will be.”
Other doctors who I’ve worked with over the years in the Whole Health Medicine Institute are totally on board to try to heal the doctor-patient relationship in this way. So we are out there. There are many of us, and our numbers are rising…
What Do You Think?
What if you printed this out and handed it to your doctor? If you’re a health care provider, how does this strike you? If you’re a patient, how do you think your doctor would respond if you handed her a copy of this? How would you respond if your doctor gave this to you?
If you’ve been hurt by the medical system or if the doctor-patient relationship hasn’t always been a force of healing for you, we invite you to come to a Zoom workshop Healing Medical Trauma. I’m calling in the best Sacred Medicine healers I know- Nia and Move To Heal founder Debbie Rosas, Intentional Creativity founder Shiloh Sophia, IFS therapist Nancy Morgan, Memoir As Medicine author Nancy Aronie, playwright Emma Jarrett, and Harvard psychiatrist and author of CURED Jeffrey Rediger, MD, MDiv.
