Aug 07, 2017

Saying Goodbye to My Patients – The Power of Relationships

“Anne, I think the reason that you’ve been more forgetful lately is because you have early dementia….” my voice cracked with emotion as I delivered the bad news.

I’d never cried infront of a patient before but sheer will couldn’t contain the salty tears that flowed down my cheeks.

Anne’s daughter, seeing my emotion and understanding the great impact of my news, started to cry too.

“Oh Jonathan, please don’t cry, I’m so taken that you would cry for me, but please don’t cry, I will be okay….I’ll be okay,” Anne softly said, her voice trailing as she reached out and touched my hand.

 Anne had been my patient for a number of years before I had started noticed a familiar vagueness in her conversation and forgetfulness emerging in her life.

After she performed poorly in a screening memory test, I’d referred her to our geriatrician, who confirmed the diagnosis of Alzheimer’s.

The reason I was affected so strongly as I delivered the bad news to Anne was that I had come to love and care for her as a patient. I had met her daughters, listened to countless stories about her grandkids and shared in her excitement in the various holidays and adventures that she’d taken and planned.

Together we’d unknowingly built the true essence of the patient-doctor relationship with our honesty, trust in each other and the sharing of our vulnerabilities.

As her GP, I’d exchanged my thoroughness and trustworthiness as a doctor for Anne’s loyalty and trust as patient.

The beauty of general practice is the shared intimacy between doctor and patient, the safe place to shed tears, share secrets, expose vulnerabilities and develop truly strong relationships.

This is the beauty that I will miss in the next year as I take a break from general practice to learn palliative care.

The true nature of general practice

The true nature of general practice is adaptive and relational medicine.

Truly great doctors understand that listening to their patients and displaying their understanding of personal circumstances is the key to better health.

Alan my 68yo patient who lived in his car, was never going to be able to exercise 30mins a day and eat low glycaemic index food to control his diabetes. He needed me to first be an advocate and reference for a rental home application before we worked on his health. One year into living in his new unit, Alan managed to stop drinking and remove the need for insulin to manage his diabetes.

Amazing? Yes, but it was inevitable seeing the role that personal circumstance and building relationships, plays in the practice of medicine.

It is all about relationships

The essence of your medical personality, nature and style is determined by those who have taught you and the patient relationships that you’ve built within your career.

If you’ve been wise to listen first, act diligently, build trust, learn from mistakes and take care of yourself, chances are that your practice is thriving and you look forward to learning from your patients.

Conversely the opposite is true. Hurt and angry doctors often continue to make the same mistakes and fall deeper out of love for medicine.

As I leave general practice for a year, the hardest part in the last few weeks has been saying goodbye to my patients.

They have all wished me well but we’ve both shared the disappointment in not being able to continue forward together.

We’ve built something much stronger than a transaction and so much deeper than an encounter and much more interesting than a bland conversation.

We’ve built a masterpiece of human relationship, centered around trust, vulnerability and love for humanity

The way forward

I’ve enjoyed every moment of being called someone’s “GP” and have relished the privilege of being listened to, argued with and most flatteringly, recommended to others as someone who would stop, listen and advocate for you.

To my patients, thank you for choosing me to share your medical journey with.

You’ve allowed me grow and find my medical voice.

The way forward as a doctor I believe is to spend a lifetime helping to relieve suffering, learning from every moment and finding contentment on the journey!

Thank you.

Jonathan Ramachenderan

Live intentionally

Love relentlessly

Enjoy your health.

This story was originally posted on The Healthy GP

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