How Close is Too Close with Patients?

When it comes to patients and doctors, how close of a relationship is too close?

One of the basic tenets of the doctor-patient relationship that every first-year medical student begins to learn is that physicians must - as a matter of professional decorum -learn to maintain a degree of emotional distance with their patients.  We are told from our very first patient encounters that we must individually discover the formula that allows us to empathetically relate to our patients, while simultaneously remaining objective enough to effectively provide the best possible healthcare.  It seems that this equation is sorted out more readily in some specialties, such as surgery where a certain aloofness has become expected, while in specialties such as mine - pediatrics - it often proves to be a much more dicey undertaking.  After all, pediatricians are generally viewed as the "soft and fuzzy" caregivers who typically go into this field specifically because they want to form close, long-term bonds with their patients and their parents.  So, the dilemma of how close is too close in the physician-patient relationship can be an ongoing struggle for some caregivers, many of whom confide that their opinions on the topic tend to vacillate throughout their careers.

I must admit that I was relieved to learn that I wasn't alone in my quest for the "perfect" balance between nurturing and maintaining enough emotional distance as I grew to know my patients.   Early on in my career, I erred on the side of being overly invested with certain families with whom I had developed a rapport because, quite frankly, I am human and this is what naturally occurs in human bonding.  Over time, though, I began to experience the dreaded realization that I could not possibly continue in this vain as I took on a larger pool of patients.   Eventually, I forced myself to step back and reassess my approach to ALL my families.  Although I didn't want to admit it, I had to face the fact that I was showing a partiality to certain patients and that just wasn't how I wanted to practice.  

During this self-assessment, it occurred to me that if my "neglected" patients ever compared notes with my "favored" patients while seated in the waiting room, a riot of biblical proportions might ensue!  I imagined one of my close-relationship parents unwittingly mentioning to other parents that no matter what time of day or night they call, I am always available and even willing to come into the office late at night to see their child.  Or, perhaps even more egregious, regaling less-favored patients with tales about summer internships I'd facilitated for their child.   I mean, can't you just envision the other parents getting "hot under the collar" listening to these accounts and thinking: "Hey, how come my child doesn't warrant such special attention?"  

After all, who could blame a parent for thinking their child is somehow being cheated out of optimal care when faced with such anecdotal evidence of favoritism.  As a parent, I know I'd be the first in line at the complaint counter if my child was being slighted!  And that's when it hit me:  The litmus test for determining the ideal balance in the physician-patient relationship is what I term the "Waiting Room Rule."  Simply put: Don't do anything in your relationships with your patients that you wouldn't want gossiped about in your waiting room; or publicized on the 6 o'clock news for that matter; or heaven forbid, plastered across social media. 

Once instituted, my "Waiting Room Rule" readily allowed me to provide more equitable attention to all my patients, while eliminating the nagging sense that I was practicing in a partisan manner. It will always be a challenge for me to moderate my tendency toward building friendships with my patients.  But, all I have to do is visualize Facebook or Twitter attacks labeling me "Doctor Favoritism" from disgruntled parents who believe their child was slighted in any way, and it snaps me back to reality.