I use to enjoy watching a television drama called House M.D. The show’s primary character was Gregory House, a medical doctor described as a misanthropic medical genus. I had to look up misanthropic. An adjective describing a person who dislikes humankind and avoids human society. Here are a few synonyms that describe his character traits: unfriendly, uncongenial, inhospitable, cynical, distrustful, suspicious, and hating mankind in general. To give you a better sense of his personality, here are a couple of his quotes. "...treating illnesses is why we became doctors, treating patients is what makes most doctors miserable." And this one, “Half the people I save don't deserve a second chance.” Does that sound like the kind of doctor you would trust with your most personal health issues? I suppose the answer would be yes, if you were desperate enough. And his patients were always desperate.
Opening scene would often times show a seemingly normal individual, who suddenly begins exhibiting a bizarre set of frighting symptoms. For example, body fluids spewing out of orifices, combined with seizures, and screams would not be surprising. Of course all this is happening while riding on a city bus. By the time this victim is admitted to the hospital and sees House, often times their symptoms would be temporally stabilized. Because in addition to their condition being totally weird, their life threatening symptoms would also be intermittent, and with no warning of onset. This made the situation even more scary. This uncertainty added a profound sense of urgency for House to find the cause. Hard choices had to be made. "I take risks, sometimes patients die. But not taking risks causes more patients to die, so I guess my biggest problem is I've been cursed with the ability to do the math."
House and his staff would typically run a tremendous amount of exotic testing and diagnostic procedures. As his staff would spout out the results, I would try to diagnose the patient’s condition before the story line revealed it. That would typically happen in the last seven minutes of the show, right after the last commercial break. Very rarely would I guess the correct diagnosis. But neither did his staff of top flight medical doctors. Interesting to notice that all the high tech and expensive diagnostics could not bring complete objectivity to the science of medicine. You see, in spite of all the impressive technology, very often House could only solve the medical mystery after receiving a flash of intuitive insight. "Reality is almost always wrong."
His staff hated and loved him, but they at least respected his diagnostic abilities. He was perceived as reckless regarding his treatment recommendations and had horrible bedside manners. In fact, the hospital administration fired and rehired him several times. So what was it about House that made us like this flawed physician? Certainly his vast knowledge of human science and medicine was to be admired. But I’m sure we all know gifted individuals that excel in their chosen field, but do not capture our fascination beyond their scope of knowledge. I believe it was his communication of unfiltered and brutal truth (at least his truth) that attracted us. His unpredictable and blatant disregard to say what needed to be said. Often hard to hear, but capturing of our attention with some kernel of truth. “Our bodies break down, sometimes when we're 90, sometimes before we're even born, but it always happens and there's never any dignity in it. I don't care if you can walk, see, wipe your own ass. It's always ugly. Always. You can live with dignity, we can't die with it.”
Here is an interesting question. If you withhold the truth, are you lying? I have to admit something. I withhold some of the truth from my patients. At least my truth. Not the clinical data points accumulated from lab tests, and ortho-neuro exam findings. Rather, the more subtle input, used to fill in the gaps to create a more comprehensive human impression. Not what they say, but how they say it. Not the information they write down on their intake form, but the specific way the words were crafted. That tells a much deeper story. Not where they walk, but how they walk. Not merely what I notice when I touch their spine. That is important, but more so, is how that feeling touches me. Overall, generally how I feel while in their presence. Suffering disguised as muscle pain, fear playing out as tension, and so much more. All these sensory impressions are relevant to knowing the person with the health issue. And I use every bit of it in my pursuit of achieving clinical excellence within my chiropractic scope of practice. But not in my verbal communication. I do withhold sharing much of these vulnerabilities with my patient. “To do what I always do in these situations. Treat my patient behind his back and make him better.”
Why don’t I just tell my truth? Because I don’t have permission. At least early in care. More on that later. But House did not ask for permission, he did not care. As a result, he pushed peoples buttons. His staff, his patients, his friends...everyone. His unbridled honesty crossed people’s boundaries. House was not there to heal his patients, he was paid to cure them. To preserve their body, like curing preserves a Christmas ham. That pig is beyond healing. His honesty was just an aspect of his personality coming through. If it touched a nerve or pushed a button and some sloppy healing happened, so be it. At the end of the day, he was still a man of science and a jaded recreational philosopher. A fictional character of a medical genus, and a jerk that makes for good entertainment.
But if facing a health crisis, you want him as your doctor. “I can be a jerk to people I haven't slept with. I am THAT good.”
I’m sure we all know someone we care about, that for their own good, needs some honest feedback. You know you should tell them that obvious detail, but because you care about them, you withhold your truth. But if you care about them, why withhold something that could be of value for them? Maybe because it is personal, it would touch them deeply, and you have not been given permission. When is permission implied? If you see a child in the road, there is no time for permission to be granted. It just makes sense. But dealing with an individual’s emotions does not often make sense.
The way I see it, health issues are always linked into some other deeper emotional concern. This requires the careful use of honesty. First, rapport has to be developed, and that takes time. A patient talks about their shoulder pain while not aware that sadness waves through their face and heaviness rises in their chest. Do you point that out? Sometimes …. But it does not take a doctor to notice suffering and diagnose it as a dis-ease. Just another person present enough to stay with the process. Just how deep do you want your doctor to go? A certain phrase spoken at the precise moment, or a light touch on a specific spinal bone can unlock a flood of deeply held feelings. When truth is authentic and used wisely, it is a powerful healing modality. "If you can fake sincerity, you can fake pretty much anything."
So what would it look like to practice health care with permission to deliver complete honesty? First, there would have to be some type of medical Miranda rights. Can you imagine my intake form with the following statement requiring your signature?
You have the right to remain ill. Any clinical finding you display can and will be used to heal you in our office. You have a right to a wholistic doctor. If you cannot handle the truth of your healing, a blue pill will be provided. Do you understand the possibilities of what I have just read to you? With these possibilities in mind, do you wish to heal?
Just pondering the possibility of such a healing environment is both exciting and frightful. You see, real healing is contagious. If you go there, I have to go there.
"Welcome to the end of the thought process."