As I get older, it occurs to me with increasing urgency that I do not necessarily inhabit the space that others do. Often I do not have the same beliefs or share the same customs; I value different things, organize my thoughts a different way; I see the world through eyes that have feasted and grown old on different sights. My experiences are necessarily unique, trapped as I am by genetics and circumstance. I should not claim to speak for anything or anybody but myself.
And yet I do. We all do. We speak from everything that has affected us, all that we have endured -or learned. We extrapolate from what has made us unique and try to make it encompass what we encounter, thinking that our own expectations and opinions are not only justified, but likely to be valuable and helpful to others. We long to meet ourselves in a crowd…
But this worries me as a doctor, charged as I am with helping others who cannot be the same as me nor want to. Why would they? What I offer them, what Medicine offers them, is a view-point, a world-view that may be at odds with their own. They come because they want help, and their need usually allows -requires- them to transcend their feelings for a while -help requires sacrifice. But even this necessity, however imperative, often stumbles at two nodes, two doors that are sometimes locked -or at least difficult to open.
The first is an impediment to seeking help in the first place, no matter how serious the problem. If the patient thinks my views are too distinct from hers, too disparate, she may not even seek help. In some contexts this concept is described as cultural safety. Simply put, will the person feel safe in disclosing her needs? Will her difference or her views be recognized and respected, or will they be marginalized and considered irrelevant, unimportant, or even silly? If she comes from a tradition that respects alternative therapies, say, -alternative to us, of course- or perhaps that prioritizes spirituality but expects this to be denigrated in her encounter with the doctor, is she even likely to make an appointment? If her friends tell her of racial, cultural, or socio-economic profiling at a particular hospital, or that the type or even quality of care seems to depend on what stereotype she fits, might this affect her decision to seek help, or at least delay it until she is desperate? I think so.
Or the if doctor is solidly imprisoned in his own views and so convinced of their truth and validity that he cannot or will not listen to your discomfort and try to see your problems as you do, will he be able to help even if you agree to see him? For many people, the concern, the fear, that their own opinions will be mocked, or not taken seriously is an impediment to treatment. Health, wellness, is in many respects subjective. How we feel about ourselves, how others feel about us is part of the equation that defines health. Disease apart, we are how we feel; we are the sum total of a multiplicity of parts that we somehow integrate into a functioning body, a sensing organism. Our opinion matters, if only to hold things together, grant them their eccentricities, tolerate their distinctive habits to which we have long grown accustomed. Who better to know me, than me?
A doctor ignores this at his -and your- peril. It is a difficult world for some to enter; some of us merely talk through a sort of window from the safety -the authority- of our office: encounters at a distance, diagnoses from the opposite side of the desk. Others pretend to understand but only outwardly -thoughts easily readable through body language by anyone nearby. There are a few doctors truly gifted with agape but most of us, try as we might, are creatures of our past.
And so what’s the answer? How can a doctor ever hope to help anyone? Surely each of us is an other, a stranger to anyone but ourselves. We all come from disparate backgrounds so what we hear is filtered, what we encounter: a confirmation bias; it makes us fallible and closed. And yet…
And yet if we take the time to listen to the other and listen with respectful curiosity -dignify their thoughts and opinions with our considered silence- we have come a long way. A hard part of illness is just being heard. After all, listening is how we form opinions in the first place; its how we learn; its how we connect; its how we understand… Listening enables relationship. It’s part of how we heal -a larger part than we may think.