No, I am not talking about estate planning. Rather, I want to ruminate for a few hundred words on the awesome magic of the trust that society in general, and our individual patients in particular, place on physicians in general, and each of us in particular.
Sometimes I am blown away by the deeply personal and intimate secrets that patients tell me. My days are regularly sprinkled with stories of betrayal, selfishness, individual failure and turpitude. Often these stories involve matters so deeply personal they have never been revealed to the person’s spouse or best friend. And sometimes the stories come from people I have know for all of 60 seconds, the time it takes to introduce myself, exchange some perfunctory pleasantries, and inquire how I can help today.
An established and successful professional man, whom I have seen for years, asks me at the end of a visit to help him get off speed. A middle-aged woman who has a benign medical history and comes in only occasionally breaks down without warning and describes being sexually abused in childhood. A young man I have just met confesses his infidelity to his wife of one year, after asking me to check some bumps on his penis.
I have heard countless stories of loneliness deep within marriages brief and long, sexual frustrations, grief due to uncaring and heartless children, grief due to uncaring and heartless parents, and families disintegrating over inheritance conflicts.
Sometimes I am embarrassed by these stories, sometimes I am enthralled. Also, to be honest, sometimes I am bored out of my gourd. How many tales of selfish children and unsuccessful marriages can one physician take? And how do these stories of woe relate to the person’s medical condition?
But what consistently strikes me is the way that people I barely know open up their lives to me in the most intimate way. It is amazing, and it shows more clearly than anything else the awful and wonderful responsibility we in health care bear. People trust us. They trust us in ways they to not even trust their spouses. They place on our shoulders the burden of secrets that cannot be shared with anyone else. Think of it! In telling us their most intimate fears and failings, people are trusting us to both share their lives and help them vanquish their demons.
Behind the closed door of the exam room, a form of deep and trustworthy communication unfolds that is crucial for each individual’s well-being. When we enter that room and close the door on the outside world, we open another door for the patient in front of us to trust us with their lives. We have to uphold that trust because society expects it, and because the individual patient needs it.
I am sobered and humbled when I think about this role I have entered. It is a role unique and irreplaceable. People do not tell their plumber about their indiscretions. They do not reveal their anxieties to their tax preparer. And they certainly never sit down with a total stranger and discuss their infidelities. Not unless that stranger is a physician.
In the midst of a really, really bad day in the clinic or on the wards, it is sometimes hard to feel I went into the right line of work. There are other ways I could make a living and contribute to society. But then I think about this amazing role I have assumed. I remind myself that Mrs. Crowell, my next patient, and Mr. Sanchez, the one after her, are trusting me to be there for them. Who knows what they will need to say? As tired as I might be, frustrated by the way the day may be unfolding, when I enter that exam room and close the door, I am opening my arms, my ears, and my heart to the trust that person will bestow upon me.
Sometimes this responsibility draws me up short. I am not sure I can legitimately play this role. What right do I have to be trusted by these people? How can I possibly live up to their expectations, let them know that their trust in me is well-founded and I will actually try to help? But then, on further reflection, I recall the honor and grace of my profession, and decide once again, as I always do, that I must at least try. I square my shoulders, marshal my soul and spirit, and think about what an amazing calling is this field called medicine.
Trust. It is so awful and so wonderful, so frightening and so humbling, all at the same time.
(July 2001)