Addressing the Fine Line Between Identification and Intimacy

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Can we truly build intimacy with our patients if we don't identify with them?
Can we truly build intimacy with our patients if we don't identify with them?

To say there is no fear in the examining room is an inaccuracy. I'm not only talking about patients here: physicians may harbor just as much worry and discontent. 

There are the old standbys, of course: The SWAT team of malpractice attorneys lounging in the waiting room ready to pounce, or the old demon of misdiagnosis and the consequences that may follow. 

A few of us talk of that sinking feeling that comes with the realization that in the course of doing our jobs, we invite physical danger. 

During medical school, I remember a psychiatric patient who barricaded one of my peers in an interview room. The standoff lasted 45 minutes until my peer was able to escape unscathed, at least physically. 

I can no longer count the various times I have treated criminals, psychotics, or just plain agitated patients with dementia who were willing to take a swing at whomever was in reach. For the most part, these interactions have melted away quietly, leaving me with few lasting effects. 

My escape from the traditional examining room has also brought a new set of challenges. Knowing a patient had a loaded gun a few feet away was somewhat jarring, or traveling to a not-so-safe neighborhood during erratic hours. 

One becomes aware of the surroundings more quickly. There are countless dangers that won't bow to our flowing doctorly lab coats.  

But by far, our biggest unspoken, and often unrealized, fear is that of identification: How does someone break the horrifying news to a dying young person and not look in the mirror and see a similar countenance? How do we not envision our spouses, our parents, and our children in every hapless medical misadventure we are a party to?

The answer is that we don't: We use our walls to create a sense of otherness. We shield ourselves to such an extent that, in my 20-year career, I have rarely had these conversations with colleagues. 

And as I get older, I wonder whether we should. There is a certain intimacy in identification that has been lost on those that hide behind the stethoscope, but we give ourselves a pass.

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