Friday, November 24, 2006

Rex Morgan Medicine: One of the most unrealistic aspects of cartoon doctor Rex Morgan, MD and his wife nurse-clinician June, is the way they insert themselves into the lives of their patients. They must have the ultimate concierge practice - only one patient needs them for months at a time. But of course, they must insert themselves, or they wouldn't have a story line.

However, in the real world, there are evidently doctors who assume active roles in the lives of their patients. From a NEJM review of Rita Charon's Narrative Medicine: Honoring the Stories of Illness:

As Charon's story unfolds, we see her paying for one patient to join a gym, providing (guided but amateur) psychotherapy to another, and springing a third from a nursing home to care for her in the patient's home. Having come to know patients through the sorts of stories that link us to our friends and relatives, she responds as a whole person to them as whole people, unconfined by the traditional strictures of her profession (and sometimes, as she acknowledges, teetering on the edge of riskily inappropriate behavior).

Why would appreciating a patient's life story (or "narrative") necessarily lead to the crossing of boundaries like that? It's possible to appreciate another person's humanity without entwining ones own life with theirs. Psychiastrists have been listening to their patient's narratives since the dawn of their specialty, and are especially sensitive to the temptation to break professional boundaries. Those traditional strictures are there for a reason.

P.S. This is still the best version of Rex Morgan - ever.

 

2 Comments:

I really don't think that appreciating the history and life of a patient should necessitate those kinds of transgressions. Granted, I haven't cracked my copy of the book yet (I'll read her story when I get home), but it seems to me that paying for a patient to join a gym, for example, is inappropriate behaviour for a physician. If she has become that friendly with the patient, she should be treating him/her?

I agree with the premise that narratives in medicine do matter. We should know the story of the patient beyond "my ear hurts" - but knowing and responding to the patient as a person does not automagically mean the sort of interference that appears advocated in this short exerpt.

By  Kelly Hills, at 11:24 PM  

But Charon is a post-modernist, and so the rules do not apply to her.

By  Anonymous, at 5:26 PM  

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