1.8.08

Paradigms - Part I: Medical Care for Friends

We were asked the other night how we felt about being the medical provider for our friends. This is hardly a theoretical question, as Rachel has agreed to provide obstetrical care for a good friend of ours. The institution of medicine does not provide a definitive stance on this, but it does provide a thought framework that lends itself to a certain position: We are uncomfortable with it, because though it may be enjoyable and rewarding as long as everything is straightforward, the possible threat to our personal relationship that is created by a possible bad outcome is a risk most are not willing to take. You are caring for a friend, and they are diagnosed with late-stage cancer. Will you ever be able to forgive yourself for not finding it sooner (even if there is nothing to forgive)? What will become of your friendship and the relationships you hold in common?

We recognize that we had better make peace with this. If my appendix ruptures in a couple years, Jason Fader will become intimate with my colon, and will have to deal with the responsibility of operating on me. If little Elise Cropsey gets malaria, it will likely be my treatment plan that will recuperate her. This is part and parcel to a desire to work in an area where there are minimal other medical providers.

The medical paradigm that creates these (and other) levels of discomfort with treating friends seems to be this: You are the patient. You are coming for help. I am the doctor. To best help, I need to be disconnected, and thus objective. I should not be bringing my personal story into yours, because this is about you, not me. And from this comes a separation between your patients and your friends, for friendship requires a give and take, an intermixing of personal stories. I think that our pastor at Knox was correct is stating this is likely an outgrowth of medicine’s modernistic bent.

And so I question this: Is it really possible to separate yourself personally from the patients you treat? If so, does this really provide objectivity? Does objectivity lead to healing? (If a person can be treated as a scientific physical specimen, then perhaps.) Is this a paradigm that will make a drop of sense in Africa? Is this consistent with Christianity?

More to come, but I would appreciate any thoughts from those who may read this.

1 comment:

Ellen said...

Unlike medicine, psychology does had a definite stance on this: that there should be no "dual relationships." However, I, as a Christian counselor, have decided to counsel people I know especially in the body of Christ. Now there are certainly friends/family I'll opt not to treat when it may be too emotionally complicated or pose conflict of interest because of the nature of our relationship. However, as a principle, I believe that counseling is done best within the local(covenant) body, hence a degree of shared life and friendship. In counseling, where I'm supposed to care for someone's soul, I think it's almost artificial to say I only care for you as a client 1 hr/week in this office but can't relate to or care for you as a person outside these walls. I think clients benefit from knowing that you not only treat them nicely because they are your clients but that you genuinely care for them. Seeing people I know certainly does pose added challenges to both parties in terms of the level of trust needed and keeping appropriate boundaries outside of the counseling office, but it's been worthwhile.

Just as a side note, even ACA (American Counseling Association) is loosening up its ethics standards on "dual relationship lately" (dropped the term entirely from their latest code of ethics) recognizing that certain dual relationships are actually helpful. They now see that a counselor going to visit a client in the hospital or attend their graduation, etc. can be beneficial to the therapeutic relationship.