Giving and receiving

Several years ago, I was packing my panniers with presents that patients had given me for Christmas. I felt embarrassed by their generosity. My patients then, as now, were for the most part pretty impoverished, and yet some had gone to considerable trouble to buy me gifts and wrap them carefully. Troubled by this I spoke to one of the other GPs who had been there for several years.

“I think of it like this”, he said. “First of all, sometimes of course a gift is just a gift, a straightforward expression of gratitude. But don’t forget too, you’re in a powerful position: all day long people who need help come to you and you do whatever you can for them. They give you their stories and share their pain, their worries, and their misery and then apologise to you for being a burden, and they mean it. No matter what you say, a lot of patients feel guilty for giving you nothing but grief all year and this is an opportunity for them to give you something different for a change. If you refuse, then you’re basically saying to them that you’re the one who dishes out the sweets and they’ve only got sour grapes and that’s the only way it can be. Accept the presents graciously, it means a lot to them and it should mean a lot to you too. Your patients care about you, and caring for others is one of the things that makes a hard life a bit more bearable. For some of course, you’ll have gone the extra-mile or diagnosed them with something really important, and for others there’s precious little kindness in their lives and you’ve been a part of that. For you perhaps it’s just business as usual, but look at it from their perspective, it’s anything but business as usual, it’s incredibly important, and giving you a present is their way of letting you know that.”

“I can’t help but feel uncomfortable though …” I started.

“Well that’s hardly a surprise,” he continued, “If you read the medical journals or the tabloids, you’ll be bound to think that presents are incendiary devices that you should treat with extreme caution because they’re loaded with the assumption that patients cannot be trusted and your moral integrity can be bought. And for what? A box of Turkish delight? It’s interesting and more than a little depressing to see the misanthropic fog of mistrust that hangs over us.”

“But I’ll grant you, It can be difficult for some of us to accept presents, I used to feel like that myself. It starts off with feeling inadequate, ‘what did I do to deserve this? I’m only doing my job!’ We propagate the idea not only that we’re not deserving, but that we don’t need affection, as if that’s a weakness that afflicts patients, but doctors are immune. We’re even uncomfortable using our humanity. It’s a sad fact that modern medicine instils in us the idea that it’s OK to treat patients with dangerous drugs, but somehow unprofessional to treat them with kindness, empathy and compassion. If these things leak into our practice, then we’re almost apologetic. As if that’s what homeopaths do, but not ‘real doctors'”.

“I suspect you’re the kind of person who feels uncomfortable with praise.” I nodded, “That’s because we think that people should only get what they deserve and we don’t deserve our patients’ kindness. Patients don’t deserve colitis or cancer, epilepsy or infertility either, though goodness knows they often think they do, and sometimes we even feed into that. And I’ll bet that if you try to reassure them and tell them that they’re wrong, that it’s not their fault, nine times out of ten they don’t believe you.” I nodded again, “That’s because we’re bought up in a culture in which just deserts are what you get for doing something bad, but being good is just how we ought to be, so it’s not deserving of attention. And the healthcare professions have made kindness a professional competency instead of celebrating it as something wonderful, which we should do, because it is.”

“Kindness is a choice we make. When we choose to listen and attempt to understand what our patients are feeling and what they need, then we’re choosing to be empathic. We demean this by saying that it should just come naturally when in fact it’s bloody hard work, especially when you’re at the end of another twelve hour day and in receipt of so little kindness or empathy yourself.”

“So think about what these presents mean to your patients and what they mean to you, be kind to yourself and be grateful.”

Wonderful lecture/ workshop on Non Violent Communication that inspired this blog

5 responses to “Giving and receiving

  1. Love this. It’s very similar to the “Zip-It” challenge I offer to almost all of my coaching clients (many of whom are nurses and midwives). It’s about the other presents they are offered – the praise, thanks, acknowledgments and recognition for a job well done or for simply showing up and being themselves. So many of us have learned to say “it’s just my job” or “oh no, it’s nothing” or “oh, this old thing, I’ve had it years” etc etc. It’s the same as refusing the box of turkish delight. So the zip-it challenge is to say smile, say thank you and SHUT UP!

  2. Jonathon, I’ve been sharing your blog posts with others.

    At http://www.smartpatients.com your post on (not) blaming patients got a huge response from both patients and parents.

    And at my blog, I’ve been writing about humanizing medicine for many weeks. Because I live with both a rare genetic disorder and metastatic breast cancer, I’m in a unique position to reflect on a lifetime medical experience. I think, feel and act as if I’m co-creating a medical system with practitioners, parents and other patients. A culture of caring and kindness is made by all.
    https://www.mylifeline.org/StephanieSugars/updates

    Jonathan, I’ll share your post at my blog today, because it’s “right on”, as we say in California.

    warmest healing wishes,
    Stephanie

    • Thanks Stephanie, very much.
      It means a lot to me that my attempts to explore the relations between doctors and patients resonates with people who might be thousands of miles away. As I said in my last blog, I don’t think we (in the healthcare professions) are very aware of the philosophical foundations / assumptions on which our practice and professional behaviour/ attitudes stands. I hope to continue to shine a light there and in so doing improve the quality of the time that we have together,
      With very warm wishes,
      Jonathon

  3. I got a massive branch (multiple bunches) of bananas, half a dozen sugar canes and a sack of sweet potatoes today from a grateful patient. Pity I can’t post the photo here!

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