Hugs from my inpatients

[northernpsy]

Sometimes when I am saying goodbye to a patient discharging from my inpatient unit, they will want a hug. I'm not really a hugger even in my personal life, but so far these requests have seemed benign (that is to say, not from patients who seemed sexually inappropriate or aggressive - I am a female myself and these requests have come from older female patients) and I felt like it would do more harm to say no than to do a quick hug, so I've gone with it.

But...I just had a patient who went for the hug, but also gave me a kiss on the cheek with it. 😱
Well, at least it wasn't on the lips.

Still, it made me want to start a thread on hugs in patient encounters.
I will still allow patient hugs when it seems like the most appropriate and kind way to react to a patient. However, this experience did make me think about situations where I may need to kindly decline a hug. If any of you have been in situations where you felt you had to decline a hug, how did you do it in a gracious manner?

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[Doctor Bagel]

Sometimes when I am saying goodbye to a patient discharging from my inpatient unit, they will want a hug. I'm not really a hugger even in my personal life, but so far these requests have seemed benign (that is to say, not from patients who seemed sexually inappropriate or aggressive - I am a female myself and these requests have come from older female patients) and I felt like it would do more harm to say no than to do a quick hug, so I've gone with it.

But...I just had a patient who went for the hug, but also gave me a kiss on the cheek with it. 😱
Well, at least it wasn't on the lips.

Still, it made me want to start a thread on hugs in patient encounters.
I will still allow patient hugs when it seems like the most appropriate and kind way to react to a patient. However, this experience did make me think about situations where I may need to kindly decline a hug. If any of you have been in situations where you felt you had to decline a hug, how did you do it in a gracious manner?

I don't have a set rule, and there are certainly patients who I accept hugs from at discharge (elderly, sweet ladies with thought disorders, etc). I often try to divert a bit to the side hug thing, though, and am more likely to move to a handshake with men and people with personality disorders. I'm not much of a hugging person myself but am not anti-hug I guess. I've never had a patient try to kiss me though -- I wonder if it's a cultural thing where kissing is a common greeting with them. With diverting hugs, I try to be casual and a bit jokey about it and just say I prefer to shake hands. It's generally accepted.

 

[J ROD]

No hug...........Handshake and I wish you well. Hence, I will see you soon after you relapse.

And, no I am not jaded at all.....lol

 

[Jules A]

I agree that if there aren't overt contraindications although I'd rather not I am ok with a quick hug. Like Bagel noted I also attempt to position for a side-hug. Thankfully no one has planted a kiss on me but I'll keep that in mind going forward and start angling my neck away in accordance with my pelvis, lol. Actually I'd almost rather hug than have to touch their hands and in rare cases depending on the patient attempting to shake I'll excuse myself as having a "cold".

 

[birchswing]

"Drugs, not hugs."

 

[OldPsychDoc]

Fist bumps.

 

[milesed]

I agree with the side hugs only Jules A mentioned. It's pretty hard to misinterpret that as sexual and harder for them to kiss you at that distance.

 

[Psychotic]

Telepsych for the win...

 

[thoffen]

You are between a rock and a hard place, having to choose between a boundary crossing or the consequences of rejecting a patient's wish. There are cases where it is clear where the boundaries should be, and I think most patients see that level of physical contact as such (why they are not hugging often), but then there cultures where hugs and beyond are appropriate on professional relationships.

The catch 22 here is that you will not have an ongoing treatment relationship for which to explore the hug or non hug.

Thus I agree with some version of a side hug. Not rejecting the request and also making it clear the boundary of the relationship.

 

[cookymonster]

Very rarely do I have patients ask for hugs. What I can't stand are the two ECT patients I have who call me by my first name. I haven't figured out a good way of remonstrating them without feeling rude.

 

[birchswing]

Very rarely do I have patients ask for hugs. What I can't stand are the two ECT patients I have who call me by my first name. I haven't figured out a good way of remonstrating them without feeling rude.

Because of the culture I'm from, I'm more comfortable being called . . .

I still wouldn't do it. But if I did, that's how I would do it.

 

[Ceke2002]

But...I just had a patient who went for the hug, but also gave me a kiss on the cheek with it. 😱

Didn't include a kiss, but I had one of my old family GPs do the same thing to me ages ago. He'd been my Doctor since my mid teen years, I was still seeing him in my early 20s and he had to deliver some bad news to me one time (or at least news I didn't see coming) - so end of session, I thank him, get up to leave, he goes to stand by the door to politely usher me out and next thing I know he's just thrown his arms around me and *squish*. It was completely non sexual, but it was still a tad disconcerting because it made me feel like he was the one who actually needed the hug, "there, there, Doctor, it's okay, delivering unwelcome news is part of your job, you'll be okay".

 

[Ceke2002]

What I can't stand are the two ECT patients I have who call me by my first name. I haven't figured out a good way of remonstrating them without feeling rude.

I wish I had some suggestions for you, this is a huge no-no for me as well. Not addressing a Doctor by their correct title? Are you kidding me? That to me is the equivalent of not addressing a Priest as 'Father'. It's you're bloody title FFS, you earned it, people should respect it and learn to address you properly.

 

[birchswing]

I wish I had some suggestions for you, this is a huge no-no for me as well. Not addressing a Doctor by their correct title? Are you kidding me? That to me is the equivalent of not addressing a Priest as 'Father'. It's you're bloody title FFS, you earned it, people should respect it and learn to address you properly.

It's all cultural. In Sweden, everyone goes by first names. When I first moved there and tried to address a teacher as "Mrs." they laughed. In Iceland, last names are used so infrequently in addressing someone that the phone book is listed by first name. But in Germany, people have at least one title, sometimes three in a row in front of the last name. In the US, it depends. When I worked at Apple, we had a style guide for how to address people and it varied based on area of the world. Interestingly, all of the US was first-name, definitely showing the California bias. Here in Virginia when I call the power company, the person that picks up says, "Hello, this is Ms. Stephanie." Really (to me) old-fashioned. When I first moved here, it was a huge culture shock. For many years I found myself feeling put upon. But then I came to the conclusion that it's about comfort. The one exception is that when we moved here my friends' parents made my parents accept being called Mr. John or Ms. Mary. My mom led a girl scout troop, and there was a lot of pearl-clutching going on once the parents found out my mother had introduced herself by her first-name and there was a parking lot showdown I was witness to where they all confronted her over it. My rule is to call people what they are comfortable being called. She was not comfortable being addressed in a way to her that seemed like something out of Roots.

 

[Ceke2002]

It's all cultural. In Sweden, everyone goes by first names. When I first moved there and tried to address a teacher as "Mrs." they laughed. In Iceland, last names are used so infrequently in addressing someone that the phone book is listed by first name. But in Germany, people have at least one title, sometimes three in a row in front of the last name. In the US, it depends. When I worked at Apple, we had a style guide for how to address people and it varied based on area of the world. Interestingly, all of the US was first-name, definitely showing the California bias. Here in Virginia when I call the power company, the person that picks up says, "Hello, this is Ms. Stephanie." Really (to me) old-fashioned. When I first moved here, it was a huge culture shock. For many years I found myself feeling put upon. But then I came to the conclusion that it's about comfort. The one exception is that when we moved here my friends' parents made my parents accept being called Mr. John or Ms. Mary. My mom led a girl scout troop, and there was a lot of pearl-clutching going on once the parents found out my mother had introduced herself by her first-name and there was a parking lot showdown I was witness to where they all confronted her over it. My rule is to call people what they are comfortable being called. She was not comfortable being addressed in a way to her that seemed like something out of Roots.

Yeah I can definitely understand different cultural aspects. When I lived with a family in Germany for a couple of months, although it was something that was becoming less and less insisted upon, there were still people (mostly the older generation) who would become quite affronted if you accidentally used the more informal 'du' when speaking to them rather than the formal use of 'sie'. I will freely admit as well that in the context of modern Australian culture I am probably a lot more old fashioned than many others in my age bracket or below - it's just the way I was raised, you always show due deference by addressing people by their correct title.

 

[Ceke2002]

So curious, why do patients ask for hugs, let alone just launch themselves at you, when they should know and understand there are boundaries in place? Seems a little selfish to me, like 'I don't care about your bondaries, gimme what I want!'. The one and only time I had a fleeting urge to randomly hug my Psychiatrist wasn't because I needed a hug, it was because there was a moment where I thought he looked like he needed one - but like I said, fleeting urge, very quickly reigned in and dissipated, especially seeing as a) Holy inappropriateness batman!, b) I figured it probably wasn't the brightest of ideas to just go launching myself at my very, very non hugging Doctor, even if there were good intentions at play, and c) Considering he could have kicked me in the head from a standing height, yeah, probably best not to take the risk. (er, not that he would have done that of course, my Psychiatrist doesn't literally go round trying to kick sense into his patients 😉)

 

[northernpsy]

I'm enjoying the thoughts everyone has shared here - and the jokes. 🙂 Gotta perfect my side hug technique I guess.

As far as what patients are looking for when they ask for hugs, I am sure that the more analytic types here will have some fantastic theories. 🙂 Personally, I think it's probably not anything negative in most cases. Even though inpatient stays are usually fairly short, it can still be intense when you're making someone talk about very personal topics every day for several days in a row. I think sometimes they just want to acknowledge that we formed an emotional bond of some kind and show some appreciation if they think I helped them. Yes, even though I don't have a particularly strong urge to hug them myself, I do feel a bond with many of my patients. It's not unusual for me to think back on former patients and wonder how they are now that I have not seen them for a while.

Out of curiosity, Ceke, did you ever get a chance to tell your psychiatrist that you had that urge to hug him? 🙂

 

[Ceke2002]

Out of curiosity, Ceke, did you ever get a chance to tell your psychiatrist that you had that urge to hug him? 🙂

No, I didn't. It was the last session before he had to take some extended leave, and when he came back it felt like too much time had passed to just randomly bring something so fleeting up. Besides it didn't feel important to the therapy work we were doing, apart from confirming stuff he already knows (that I have a bit of a caretaker personality, sometimes to my detriment). It was a while ago, I had good reason at the time for having an urge to give him a hug, I had an equally good, if not better reason to not do it - going into the wherefores and whys of the situation just didn't/doesn't seem all that necessary. 🙂

 

[Crayola227]

So curious, why do patients ask for hugs, let alone just launch themselves at you, when they should know and understand there are boundaries in place? Seems a little selfish to me, like 'I don't care about your bondaries, gimme what I want!'. The one and only time I had a fleeting urge to randomly hug my Psychiatrist wasn't because I needed a hug, it was because there was a moment where I thought he looked like he needed one - but like I said, fleeting urge, very quickly reigned in and dissipated, especially seeing as a) Holy inappropriateness batman!, b) I figured it probably wasn't the brightest of ideas to just go launching myself at my very, very non hugging Doctor, even if there were good intentions at play, and c) Considering he could have kicked me in the head from a standing height, yeah, probably best not to take the risk. (er, not that he would have done that of course, my Psychiatrist doesn't literally go round trying to kick sense into his patients 😉)

Eh, well, some patients don't have good boundaries or know how to respect others' boundaries, etc etc why they might try or ask for a hug. Most of the time I'm sure it's benign.

My PCP just asked me if needed a hug at the end of the visit when I was sobbing, and really held on for a while. I ended the hug when I wanted, but it was nice they let me have as much hug as I needed. Of course, they knew me from the time I was their med student!!

If a patient asked for a hug and I wanted out of it, I would just say, "I'm sorry, but I don't feel comfortable hugging any of my patients. Some, and I don't mean you, might take it the wrong way. If I hug some and not others that could also be taken the wrong way. So it's just a blanket policy I have. I would like to give you a good handshake if you're up for it." And give the two handed handshake.

Despite that song and dance, I do think it's OK as a doc to offer hugs, you just need to phrase it so the patient has an out. "I would like to offer you a hug if you need it. If you're OK without one, that's fine."

 

[Crayola227]

As far as titles, somewhere I wrote a rant about it.

Here in the US at least, it is the custom to be addressed as Doctor. I stand by this for many reasons and have an idea how to correct people.

In inpt settings where likely there are multiple types of roles on the healthcare team that patients are interacting with, many can appreciate the following approaches:

If you're a lady, it's pretty easy. "I prefer to be called Doctor So-and-So, since it's not uncommon for a lady doc to be confused for a nurse, and I just prefer that my role on the healthcare team is clear and doesn't create confusion to my role for anyone on the team or for patients."

The example of the ECT patients or others that I assume have met others on the team, "I prefer that patients use my last name and call me Dr. so-and-so. There's a lot of people on the healthcare team, and as you have met, many nurses and others that go by their first name. By establishing that everyone calls me Doctor, I can ensure that anyone that overhears you addressing me doesn't get confused what my role is on the healthcare team."

If it was in a one on one scenario like outpt clinic, I would say, "Oh gosh, no one ever calls me by my first name while I'm working with patients. Feels sorta odd! If you don't mind, I'd rather you call me Doc So-and-So so I don't get confused!" - little joke there to soften the request.

I think for our culture, using the title Doctor So-and-So implies that we are a trustworthy authority, and while we are moving away from a paternalistic style in medicine, I think that's important for the therapeutic alliance. It's not for the benefit of your ego as much as helping instill a sense of confidence on the part of the patient towards you. I think the wee bit of distance you get from the formality is also healthy for the relationship. This is similar to the respect we show police officers in addressing them as officer, teachers we address as Professor ___ , Doctor where approprorpiate, Mr/Mrs, and Senators, President, Judges.

Establishing that you're Dr. So and So has helped me many times with elderly or confused/delirious/demented patients. They can come in clear, get to know you as Doctor So and So, and then later get confused/delirious. I've had some get downright paranoid about the nurses and not believe them where they are (hospital) and think they are out to get them. It's pretty gratifying to help the team and the patient just by coming down in the white coat and have them recognize you by Doctor, white coat, or your stethoscope (lol or even just conflate remembering!). Some even if they don't remember me I can usually convince I'm a doctor, and as such, I am there to help them. Even with all the mistrust of doctors going around these days, *most* people don't think we're actually out to get them on purpose. Obviously with mental health there will be times where it doesn't help you.

I'll also use the coat and steth to help redirect patients to where we are. "See, you're in a hospital. That's why I'm wearing a white coat and have on one of these {holds up steth}. I'm Doctor So and So."

Psych don't get so much mileage out of the coat or steth. If it were me, I might have one of them on hand close by as my costume to help the patients I've described. If I was outpt I might at least keep a steth handy when I was interviewing certain patients so we could keep returning to the fact we're having a doctor visit (seen some TBI patients that benefited from the symbolism.)

Anyway, this isn't about ego but more about what I think of the psychological value of some of the ritual or symbolism in medicine and why I think it values patients. At least in the US where we do value hierarchy and more formal roles.

 

[randomdoc1]

What do you guys do with hugs that are just sprung on you? That is, from well meaning and stable outpatients. I've had a few elderly veterans do this (hug with no warning), very lovely people and just didn't have the heart to break the hug. I didn't return the hug either, I just stood there stiffly and awkwardly (then later explained why). Not the most graceful move, but I was early in my residency. Actually...not sure I'd manage it much more gracefully even now...

 

[Crayola227]

What do you guys do with hugs that are just sprung on you? That is, from well meaning and stable outpatients. I've had a few elderly veterans do this (hug with no warning), very lovely people and just didn't have the heart to break the hug. I didn't return the hug either, I just stood there stiffly and awkwardly (then later explained why). Not the most graceful move, but I was early in my residency. Actually...not sure I'd manage it much more gracefully even now...

Sounds about right. Not everything we do can come out gracefully. Just hope that when the patient does this they're not actually attacking you?

 

[smalltownpsych]

I just let the patient take the lead. I have yet to receive an inappropriate hug and most patients will ask before. Being male makes a big difference in this though. I had a good discussion with a female colleague the other day and she has been asked out by patients more times than she can count. My patients have never even come close to doing this. The most they have done is to comment on my looks or even attractiveness a few times. I just said thank you and moved on. If I was a female therapist, I would probably need to have a very strong no-hug rule, but as a male, it just seems to be less of an issue. Also, population and setting and regional/cultural differences come into play. When I worked in California, I was getting hugs all the time. I remember a scantily clad and developed teen girl hugging me in front of the sheriffs office where I was doing a training rotation. Awkward. 😱
Where I am working now, it is pretty rare to have patients hug.

 

[Ceke2002]

Establishing that you're Dr. So and So has helped me many times with elderly or confused/delirious/demented patients. They can come in clear, get to know you as Doctor So and So, and then later get confused/delirious. I've had some get downright paranoid about the nurses and not believe them where they are (hospital) and think they are out to get them. It's pretty gratifying to help the team and the patient just by coming down in the white coat and have them recognize you by Doctor, white coat, or your stethoscope (lol or even just conflate remembering!). Some even if they don't remember me I can usually convince I'm a doctor, and as such, I am there to help them.

This just totally reminded me of something funny with my Mum when she was experiencing delirium post surgery to fix a badly broken leg. She was actually having one of her reasonably okay days, still very confused and emotional, but if you took the time with her she would eventually understand what you were trying to tell her. So the Doctor on duty comes through on his ward rounds, introduces himself, it takes Mum a few moments to register who he is, but she sees the stethoscope and hears the name 'Dr____' and understands who he is - except the Doctor happened to be of Asian ethnicity, and from then on every single guy on the entire ward who even remotely looked Asian themselves was the same Doctor she had just seen. I spent the rest of the visit with my Mum randomly pointing to people and going "There's my Doctor!"..."No, Mum, that's a Nurse"..."There's my Doctor!"...."No, Mum, that's an orderly"..."Look, there's my Doctor"..."No, Mum, that's someone visiting their relative". If you were an Asian male on the ward that day you all instantly got upgraded to 'Doctor'.

 

[northernpsy]

The most they have done is to comment on my looks or even attractiveness a few times.

Well if they were positive comments then you can take it as a compliment I guess. I once had a very disinhibited manic patient who was describing someone to me and said something like "She was a little chubby like you". Thanks, man.

 

[Salpingo]

Assuming they don't break any ribs, there's probably more harm done turning down a hug then accepting one.

 

[Salpingo]

As far as what patients are looking for when they ask for hugs, I am sure that the more analytic types here will have some fantastic theories. 🙂

I think the goal of analysis would be to articulate the gratitude and appreciation in words instead of action and physical intimacy. While that may have been achievable in the heyday of 6 month psychiatric stays, I don't think anyone has that expectation for inpatient treatment now.

 

[splik]

Ive not had a choice in the matter, usually the hugs come without warning and without my consent! However I think psychiatrists tend to way over think this to the detriment of the profession. sure, boundaries are more important in psychiatry than some other specialties, and I have never initiated a hug in psychiatry, but we may lose our humanity if we never consider it appropriate to hug patients. When I was doing internal medicine, I used to hug patients all the time (including initiating it). I had one 80-something burnt-out borderline patient, and I prescribed her daily hugs on the rounds. I didn't feel blackmailed, and it stopped her from talking about suicide or disappearing in provocative fashion (which she had a habit of doing.) Having now trained in psychiatry I would raise eyebrows at my former self, but d'you know what? It was the right thing to do at the time. Similarly as a surgical house officer I remember having to frequently break bad news to patients and although I thought I was quite good at it, I don't think I was well-equipped for the task. I remember once asking a patient if she wanted a hug (she though she had appendicitis but it turned out she had stage IV ovarian cancer) and she wrapped her arms around me and bust into tears. It was just what she needed. Everytime I saw her afterwards, though we never talked about it, there was a silent acknowledgment that were shared a powerful moment. After that, I often went I think I cared about my patients more when I didn't put all these boundaries in the way. Sometimes psychiatrists use "boundaries" as an excuse for actually getting right in their with their patients, getting into the murky emotions and the real mess of live experience, supporting them to the best of our abilities and allowing the patient to have contact with a real person. That means using touch on occasion.

I am reminded of the story of a patient with schizophrenia who used to get a hug with her depot injection from the nurse each month. Then she got a new nurse, who didn't know about the hugs (or didn't care), and the patient decompensated having been previously stable for many years.

You have to think about your comfort level, and the individual patient. But it is not usually creepers who are asking for hugs (at least for me as a man, I don't know if it's different for women). It's not just patients who need hugs, we need hugs too. Our work as psychiatrists is mostly thankless, so I certainly won't turn down a hug as a gesture of appreciation at the end of treatment. I also recently had a patient hug me when I agreed to take her on as her therapist.

Btw, I am one of the least touchy feely psychiatrists out there but have probably hugged more patients than many psychiatrists!

 

[notdeadyet]

I agree with the above that we can overthink hugs if we're not too careful. I think the only things to keep in mind are safety and consistency.

re: safety- if you are working inpatient and you find you get hugs without warning that you can't do anything about, it might be a sign that you need to work on situational awareness. If a patient on an inpatient unit is close enough to hug me without me having time to react, they are too close. As for outpatient practice, hugs in a closed office without careful forethought are bad juju in my personal opinion. What you may view as non-sexual, your patient may view differently, and absent of witnesses in a closed off room, it is hard to state your case.

re: consistency- physical demonstrations are pretty individual, but I do think it's important to have a consistent philosophy and stick to it. I've seen residents give hugs to certain patients and not others for reasons that weren't apparent to me and feelings can be hurt (and therapeutic alliance damaged). Ad hoc hugs only on discharge. No hugs with inpatients. One armed side hugs. Whatever your rule is, have a rule so that you aren't rewarding yourself or punishing others.

Me personally?
- I don't hug anyone on inpatient units. Even if it's an innocuous event among those involved, there are other people on the unit with altered mental status, disorganized thinking, and perceptual disturbances that can misinterpret. I'm not against the idea of a hug if I thought it would be really useful (in an interview room with witnesses present out of sight of other patients), but I've found that it's actually very possible to convey sympathy, empathy, and intimate understanding of patients without being physically demonstrative. The hug is kind of low hanging fruit.
- I only give hugs on outpatient units at the patient's request on final session when I think it's appropriate.
- Aborting hugs? It's pretty easy. When a patient comes in for a hug, I just say, "sorry, I don't hug patients, it's just a policy" and give a heartfelt two handed handshake with some kind words. Outpatient folks have consistently seemed to get it. Inpatient folks too, with a single exception. And frankly, that was a sign I'm glad I didn't follow through with a hug.

 

[Attending1985]

I love the sentiment about overthinking to the detriment of our profession. In residency I often felt I would be more effective in improving mental health as my patients' family physician because of all of the "boundaries" in place in psychiatry. It's sometimes hard to really connect on an emotional level because I was always expected to keep such an emotional distance which seems to alienate patients at times.

 

[northernpsy]

I have mixed feelings about maintaining rigid boundaries.
I think I definitely am more on guard about boundaries as a psychiatrist than I would be if I were in another specialty such as family medicine - let alone something like surgery (on the other hand, I suspect that male ob/gyns are probably another group of docs that have similar worries about not pushing boundaries as we do, and I think at one point I even read something here on SDN about how psychiatrists and male Ob/Gyns are two groups of docs who are at above average risk of attracting a patient stalker compared to other specialties).

Sometimes I do envy the casual, relaxed, friendly relationships that some docs in other specialties have with the patients they've been seeing for years. I sometimes think it would have been really cool to have become one of those old school type of family medicine docs who would deliver a baby and then remain that baby's doctor for life (though just recently I had a patient who I was extremely relieved was going to be following up with her family med doc and not with me, so sometimes patient continuity ain't all it's cracked up to be 😛 ). I would probably not think much of hugging a patient or making small talk about my own personal life in that kind of doctor-patient relationship.

However, I think most of us have had some powerful transference/countertransference experiences because of the nature of the conversations we have with our patients. I think all of us are well aware that it is not appropriate to date or have sex with a patient, but I imagine that not all of the doctors who end up crossing the line into misconduct with patients originally intended to let it happen. I suspect there are cases where "one thing leads to another" and the doctor lies to himself about why the boundary violation is okay (or even therapeutic) until it's too late.

 

[Ceke2002]

Sometimes I do envy the casual, relaxed, friendly relationships that some docs in other specialties have with the patients they've been seeing for years. I sometimes think it would have been really cool to have become one of those old school type of family medicine docs who would deliver a baby and then remain that baby's doctor for life (though just recently I had a patient who I was extremely relieved was going to be following up with her family med doc and not with me, so sometimes patient continuity ain't all it's cracked up to be 😛 ). I would probably not think much of hugging a patient or making small talk about my own personal life in that kind of doctor-patient relationship.

I think it depends though on whether or not you end up with long term patients as a Psychiatrist and also how stable those long term patients are. I suppose after a while experience would inform your decision with longer term patients as to which ones you could be a little more relaxed with, and which ones you'd need to stay on guard with permanently. After 6 years the working alliance/therapeutic bond I have with my Psychiatrist is a mix of being fairly relaxed and easy going, but also still very boundaried at the same time (having said that my Psychiatrist also wasn't stupid enough to risk using a more relaxed approach at times, until we'd had a chance to really get to know one another from a professional working point of view, and had established a high level of mutual trust - it wasn't like 2 months into therapy and we're occasionally shooting the breeze about some of our favourite hobbies and interests). On the other hand though if you're working long term with a patient who might be perfectly lovely when they're stable, but who also has frequent relapses of say Paranoid Sz, and turns into an obsessive paranoid stalker type when they're unwell, then obviously you're going to remain a lot more guarded in that situation. And of course loosening boundaries, doesn't mean throwing all boundaries out the window either - there does seem to be a bit of a balancing act to it, between allowing a more relaxed and friendly approach at different times, whilst still ensuring the patient doesn't mistake that for the development of an actual friendship or that the roles of Doctor and patient themselves start to become blurred.

 

[birchswing]

I sometimes think it would have been really cool to have become one of those old school type of family medicine docs who would deliver a baby and then remain that baby's doctor for life

That must be really, really old school. Have never heard of that in my time. You might like animal husbandry, though! It's kind of the same thing; although, in some areas of farming the idea is to kill the animal you deliver eventually, which obviously differs a bit from human medicine.

There is a really good series on Netflix called The Young Doctor's Notebook. It's about a young doctor in the the boonies of Russia who basically has to take care of any medical problem anyone in the area has.

 

[Ceke2002]

That must be really, really old school. Have never heard of that in my time. You might like animal husbandry, though! It's kind of the same thing; although, in some areas of farming the idea is to kill the animal you deliver eventually, which obviously differs a bit from human medicine.

There is a really good series on Netflix called The Young Doctor's Notebook. It's about a young doctor in the the boonies of Russia who basically has to take care of any medical problem anyone in the area has.

My childhood Doctor didn't deliver me, but he was my Doctor from the time I was a baby until his retirement when I was between 7-9 years old (I can't actually remember how old I was when he was retired. older than a very young child, but still enough of a child that I threw an absolute fit of resentment when I found out I couldn't see my beloved Dr XYZ anymore, and poutily insisted that my parents make him come out of retirement just for me, because I was absolutely not seeing that other Doctor who'd taken his place). He'd also been the family Doctor since well before I'd come along, so I suppose we're talking 1950's at an earliest guess, then through to the 60s, and then I was born in 1972 so from then up until late 1970s/early 80s at the most.

 

[birchswing]

My childhood Doctor didn't deliver me, but he was my Doctor from the time I was a baby until his retirement when I was between 7-9 years old (I can't actually remember how old I was when he was retired. older than a very young child, but still enough of a child that I threw an absolute fit of resentment when I found out I couldn't see my beloved Dr XYZ anymore, and poutily insisted that my parents make him come out of retirement just for me, because I was absolutely not seeing that other Doctor who'd taken his place). He'd also been the family Doctor since well before I'd come along, so I suppose we're talking 1950's at an earliest guess, then through to the 60s, and then I was born in 1972 so from then up until late 1970s/early 80s at the most.

Oh that's very nice. I have no idea who delivered me. For whatever reason I seemed to see different pediatricians as a child, and sporadically. Like maybe every 3-4 years at most. It wasn't a regular thing. By the time I moved to VA, the doctor's office I went to was a big office with one doctor and lots of NPs, and I would see different NPs each time, and again I went in very infrequently. It wasn't until my mid-20s that I consciously sought out a PCP and found a great one I've been with since. I've told him I wonder what I'll do when he retires (he's late 50s), but he said he plans to work a long time because he had kids late and has to put them through college. I really think if I had one of those doctors who followed you through childhood it would have made a huge difference when I started having the psych issues around age 14. I didn't have a doctor, so there was no one who could look at me with any sense of continuity and history. I went from an NP to a psychiatrist who didn't know me. My PCP I have now knows me really well. He actually kind of is one of those old-fashioned doctors in that he came to see me in the hospital when I had appendicitis (as did my cardiologist, which is pretty amazing). The problem is he's an old-fashioned type doctor to thousands of people—not enough of him to go around. So yeah I guess if my parents had sought out a doctor like that I probably could have had that type of cradle to adolescence doctor experience. Not the delivery part, because I think that's pretty much ob/gyn's purview, but the rest of it like you said.

 

[Crayola227]

That must be really, really old school. Have never heard of that in my time. You might like animal husbandry, though! It's kind of the same thing; although, in some areas of farming the idea is to kill the animal you deliver eventually, which obviously differs a bit from human medicine.

There is a really good series on Netflix called The Young Doctor's Notebook. It's about a young doctor in the the boonies of Russia who basically has to take care of any medical problem anyone in the area has.

you will see this less around a college town and more in places where people really settle and don't leave the area. It exists and I've seen it.

 

[Ceke2002]

Oh that's very nice. I have no idea who delivered me. For whatever reason I seemed to see different pediatricians as a child, and sporadically. Like maybe every 3-4 years at most. It wasn't a regular thing. By the time I moved to VA, the doctor's office I went to was a big office with one doctor and lots of NPs, and I would see different NPs each time, and again I went in very infrequently. It wasn't until my mid-20s that I consciously sought out a PCP and found a great one I've been with since. I've told him I wonder what I'll do when he retires (he's late 50s), but he said he plans to work a long time because he had kids late and has to put them through college. I really think if I had one of those doctors who followed you through childhood it would have made a huge difference when I started having the psych issues around age 14. I didn't have a doctor, so there was no one who could look at me with any sense of continuity and history. I went from an NP to a psychiatrist who didn't know me. My PCP I have now knows me really well. He actually kind of is one of those old-fashioned doctors in that he came to see me in the hospital when I had appendicitis (as did my cardiologist, which is pretty amazing). The problem is he's an old-fashioned type doctor to thousands of people—not enough of him to go around. So yeah I guess if my parents had sought out a doctor like that I probably could have had that type of cradle to adolescence doctor experience. Not the delivery part, because I think that's pretty much ob/gyn's purview, but the rest of it like you said.

Yeah, it was nice, and as Crayola pointed out it is more common in places where people are more settled and not moving around as much - although even then, at least from a South Australian point of view, I have noticed a shift (especially from the mid 80s onwards) between having a long term family physician, even for those people who are well established in the area they live in, and having a GP you might see for 10 years at the most before they move on to another practice. Up until my childhood/long term family Doctor retired his practice was just him and his receptionist; once he retired and another younger Doctor took over (whom I instantly took a dislike to, because as far as I was concerned this was the Doctor who'd taken 'my' Doctor away from me), and then within a couple of years it was him and another Doctor sharing the clinic space on different days, so that consistency of having the one Doctor that all the family saw was then gone. But yes I did have a child's love for my childhood Doctor; he was very old school in appearance (old fashioned white coat and all), but also very gentle and kind and patient - especially when it came to one little girl (ie me) who can remember tottering in on little 3 year old legs, all happy and excited to see Doctor, and then immediately proceeding to clamber onto his lap for a hug. 🙂

 

[Ceke2002]

I have no idea who delivered me.

No, neither do I (although I could probably find out - my Mum still has my hospital bracelet from when I was born somewhere). I know which hospital I was born in, and I do know I was late so they decided to induce Mum and then sent her home saying it would be a few hours until she had to think about coming back, so she might as well go home and have a rest - well apparently she got home and had no sooner walked in the door when she went into labour, so of course then there was a mad panic to get her back to the hospital, except my Dad grabbed the car keys, grabbed Mum's suitcase/overnight gear and through all that in the car, and then peeled off out of the drive away and got to the end of the street before he realised he'd left the most important thing behind, my Mum.

 

[Therapist4Chnge]

There is a really good series on Netflix called The Young Doctor's Notebook. It's about a young doctor in the the boonies of Russia who basically has to take care of any medical problem anyone in the area has.

You left out the best part….Harry Potter is the doctor…well..Daniel Radcliffe…..whatever.

It's a pretty funny…in a dark comedy kind of way.

--

As for hugging…I'm not a hugger in my personal life, so hugging in my professional life is avoided whenever possible. I trained with mostly SMI (both peds and adults) with a healthy mix of axis-II, so I tend to be very conservative in everything I do. In some cases I'll make an exception once in a blue moon, but I'd rather let nursing and others handle that stuff.

 

[sunlioness]

I'm a great believer in the fist bump.



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