 In
his first month of medical school, UBC med student Cailan
MacPherson discovered an unexpected facet of his new chosen
profession. Not mentioned in the Hippocratic Oath or his
med school info pack was the fact that becoming a doctor
also seems to mean joining bartenders as unofficial confidantes
to the world. During his first few visits to a family
practice, the 27-year-old was privy to so much highly
personal information that he wondered if he'd made a wrong
turn at the confessional.
"I made sure patients knew I was
a med student in my first month, not much different
from someone off the street in terms of experience,
but it didn't seem to matter," he says. "Ninety-five
percent of the people were more than willing to disclose
everything."
DR,
DR, I HAVE SINNED
It seems there's just something about the doctor-patient
relationship that makes folk 'fess up about their most
intimate problems. "One of our professors talked about
the level of trust patients will put in us, just because
they're going to see a doctor," Cailan recalls. "He
was talking about patients, including high-powered individuals
and community leaders, who will break down in tears
as soon as the door closes."
Dr Dan Ezekiel, a GP who runs a
family practice in Vancouver, says scandalous confessions
are pretty standard. "There are surprise revelations
of alcoholism, children taking drugs, couples I thought
were getting along that aren't. You hear all kinds of
shocking things."
Like what? "I've heard about alcoholism
in the family," he says. "I've heard about drug abuse
in the family, sexual abuse between couples, physical
abuse between couples, plus business problems."
This stuff can get heavy, but Dr
Ezekiel says he encourages his patients to open up about
their lives because it makes him a better physician.
"Something like 25% of all doctor's visits have a psychological
element," he says. "Even if there are physical symptoms,
they may be psychologically mediated, so it's huge to
know what's going on in patients' lives."
NO
FUN AT COCKTAIL PARTIES
Once you're left holding the secrets bag, though, are
you obliged to carry it with you everywhere without
spilling even one bean? What about those parties where
everyone's talking shop — should doctors have to
keep their mouths zipped, even if they've got a juicy
story to tell?
"You can tell a story here and
there, as long as you don't identify a patient. I don't
really think it's necessary to keep everything I do
in a day quiet," says Dr Ezekiel, who adds that the
burden of his patients' problems can occasionally weigh
on him.
"Sometimes I take situations home
with me. I have several female patients who are being
beaten by their husbands, for example, so of course
I feel bad and may talk to my wife about it without
identifying the patient."
Cailan says being bogged down with
confidences does concern him a bit. "I think a lot of
med students are generally worried about the prospect
of being exposed to these stories and problems all day,
every day," he says. "It's a particular problem for
doctors who want to work in rural areas, where the community
is so much smaller. It might be hard to remember where
people confided in you — at the office or on a
friendly hike."
SUPPORT
AVAILABLE
If things get too difficult to handle, says Dr Ezekiel,
it's important for physicians to remember that support
networks are available. "There are therapists who only
treat doctors, and the medical association has programs
for those who find they're getting into trouble."
But as long as he's got his practice,
he'll be encouraging his patients to open up. "I like
my patients to think of me as a friend...if they feel
you're not judgmental and are going to help, I think
one of the first people they want to talk to is their
doctor."
Feeling bogged
down? Contact the CMA Centre for Physician Health and
Well-Being (1-800-267-9703).
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