Role Play

Physicians play many roles in patients’ health care and lives in general.

In one encounter we may be the only one encouraging a hesitant or discouraged person to look inside and outside themselves for the strength to move forward with a difficult decision.

In the very next appointment we may be taking charge as a patient develops chest pain and shortness of breath in front of our eyes.

We sometimes find ourselves in a position where we are uniquely able to challenge our patients by saying things they wouldn’t even let their own families tell them, just because we are their doctors, because of the authority they consciously or subconsciously are willing to give us.

Again and again I find myself in situations where I, the person, might hesitate about what to say or do, but I, the doctor, sense what my archetypal role is for that patient in that moment.

I regularly find myself filled with a sense of peaceful warmth, a sense of quiet certainty that changes my demeanor, posture, voice and words, as if I am carried by a greater force. I don’t have enough religious conviction to state for sure that I am at that moment under any kind of divine influence, but I certainly know that I, the doctor, handle all kinds of difficult situations better than I, the graying and nearsighted Swede.

I believe very firmly that I am carrying on the legacy of millennia of healers, the masters of modern medicine and the mentors of my own education. I am aware of my split second reflections about what my old eye doctor, my family practice residency director or the specialists I have observed and tried to emulate would have done in a given situation.

The role I play is bigger than the person I am. It gives me the ability to rise above my own shortcomings, to enlist whatever the source of my abilities is as I move through my daily list of patient encounters.

In this era of social media, lack of privacy and challenging of authorities, doctors sometimes sabotage themselves by revealing too much of themselves. This can detract from the important roles they are called to play.

Sir William Osler once said “look wise, say nothing and grunt”. I am sure it was tongue-in-cheek and for effect, but it was a warning not to speak mindlessly. He also spoke and wrote a great deal about pursuing equanimity, defined as mental calmness, composure, and evenness of temper, especially in a difficult situation.

Both pieces of advice encourage physicians to remain a little bit removed or apart, in order to effectively carry out the roles we are called to play in ministering to the sick. They also serve to enhance our abilities of observation and listening, the foundation of medical diagnosis.

Playing the different roles of a physician is not a frivolous game or charade. It is more like being a musician in a well tuned orchestra. Our demeanor, our voice and our words are our instruments. We use them, not to shine or stand out for ourselves, but to express and deliver our measured parts in a great symphony that touches both listener and player profoundly, albeit each one of us differently.

2 Responses to “Role Play”

  1. 1 Andrew Goates April 29, 2016 at 3:38 pm

    Thank you for the profound and thought-provoking post. As a medical student, I’ve reflected on the Doctor patient relationship often and considered how I want to approach this when I begin practice of medicine. You’ve described some compelling reasons for maintaining a healthy space between individuals that actually allows for a deeper connection in order to heal. Very well stated.

  2. 2 Vic Nicholls May 20, 2016 at 10:18 pm

    I think that might depend on the person. Not all people would accept the above. The better I know how you think, the better I can predict when to call & say there’s a problem, and when not. It helps give us clues as to what to bring to you and what not.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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