The questions begin as soon as the patient or family member hears a diagnosis. They come in no particular order. Sometimes, they come frantically. Sometimes, they come slowly, but nevertheless, they come. The physician can usually predict the questions. “What are the treatment options?” “What are the chances of success? Of cure?” “How long does he or she have?” And most physicians likely have memorized research results to regurgitate. But then the patient or family asks the question the answer to which cannot be found in medical literature, “What would you do, doctor?”
As a medical student, I have listened to multiple physicians’ responses to that question. Usually, they try to slightly redirect and refocus the listeners’ attention to the clinically relevant data with the reply, “Based on the medical literature …”. I think I understand why they say that. Physicians are supposed to preserve patient autonomy and not coerce the patient to make any particular choice. Maybe they believe answering that question would be a form of coercion and by replying with literature-based data they are maintaining neutrality. But is it ever appropriate, ethical even, for physicians to answer that question? Broadening that question, as healthcare providers, is it ever appropriate to share our personal medical experiences with patients and families?
In “ A Patient Too Close to Home,” Richard Cassidy describes an encounter with an elderly Alzheimer’s patient and her family and grapples with his decision not to share his personal experiences about a close relative who also suffered from the disease with his patients’ family and the possible implications of his own experiences on his medical practice in the future. I could immediately relate to this student’s experiences. As a Trauma Survivors’ Network volunteer, I opened up easily to patients and families about my experiences as a trauma patient, but when I don my short white coat as a medical student, I hesitate before I share, if I share at all.
Hearing a healthcare professional’s medical narrative could be powerful for the patient and family. Isn’t that why they ask the infamous question in the first place? I recognize there is a time and a place for everything, and a physician’s sharing of a personal medical narrative is no different. Just as was pointed out in “Too Close to Home,” we, as medical professionals, have to learn to recognize when to tell our stories.
Katherine Guess is a fourth-year medical student at Vanderbilt University School of Medicine. Her piece, "I Need to Tell This Story" appeared in the Fall 2014 Intima.
©2015 Intima: A Journal of Narrative Medicine