Balancing Kindness and Limits to Avoid Adversarial Patient Relationships

Walking into work on Monday morning, my forehead bore the latest tale in the ongoing saga of nighttime in our home. Rare indeed is the night that one of our four kids does not wake us up for some reason.

On Sunday night, I was awoken by our toddler for all-around general malcontent. An hour later, at the bleary-eyed hour of 2:30 a.m., my daughter woke me up because “my blankets are messed up.” Now, I know what you’re thinking, because the next morning I thought the same thing. Too bad if your blankets are messed up - fix them yourself and let me sleep. But at 2:30 in the morning, I know that the quickest way back to sleep is to take 90 seconds, walk down the hall, fix the blankets, and get back to my own bed …which is what I prepared to do.

Unfortunately, when my daughter came in our room, she didn’t open the door all the way or close it behind her, leading me to walk, forehead first, into the edge of our bedroom door. It hurt; a lot. Then I felt the sticky wetness trickling down my face. I walked to the bathroom, my daughter close on my heels, to see an impressive cut above my right eyebrow, dripping blood down my face. Yes, I was tempted to turn to my daughter, bloody face and all, and tell her: “Look what happens when you wake up mommy in the middle of the night.” But, I didn’t. I reassured her, grabbed a washcloth, and walked her back to bed.

We had a pointed conversation the next morning about when it is acceptable to wake up mom and dad in the middle of the night and when it is not. I am creeping closer to my husband’s solution of locking our bedroom door at night.

In my zeal to be a kind, compassionate, available mommy, I tried to do the right thing but ended up doing the wrong thing, causing injury to myself in the process. It’s gotten me thinking about all the ways - at home and at work - that I try to be nice or accommodating or kind or generous when I actually need to be decisive and firm.

This conversation has recently erupted among my partners. Chronic pain management is fraught with frustration on all sides. Patients are often demonized by the medical system, looked upon as needy junkies who are just trying to manipulate us. In truth, most patients use their narcotics appropriately. As physicians, we have to be wary of the patient who is abusing the medications. We do drug screens, sign pain contracts, view with suspicion any unusual requests. We do it for a perceived greater good. We don’t want our patients to become addicted. We don’t want our patients to overdose. But, it puts us in a uniquely adversarial relationship with our patients.

This is my concern about requests made by kids and patients alike - that I will be adversarial in a relationship that is supposed to be founded on trust and kindness and compassion.

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