Monday, February 05, 2007

Playing the favorite

It is the cardinal sin of parenting to divide affection unequally between one’s children. The favored child certainly may flourish, but the disfavored one, starved for attention and encouragement, is assured of failure to thrive. Just as for twins in the womb, when even the slightest imbalance in blood flow can lead to devastation for the malnourished infant, so too for children in a home can parental favoritism disrupt and destroy the growth and development of the neglected child. Hiding it is of no use, for children will not be deceived; they are exquisitely sensitive to any tempering of the affection that is their birthright. Even an abusive parent, if that abuse is consistently applied, is more tolerable to a child than a parent who dotes partially, as the latter’s bias ruins the sibling bond that otherwise makes almost any hardship bearable.

So too with medicine, we should not play favorites among our patients. Regardless of race, religion, class, sex, mental capacity, or disposition, all patients should be granted the same high professional level of care – that is one of the bases for our fiduciary contract with society. We must work to overcome any personal prejudices. Additionally, we must strive to provide the malodorous patient, the tedious patient, the verbose patient, the histrionic patient, the belligerent and verbally abusive patient, and even the patient who refuses treatment with an equal quality of care to that of our most likable patients, regardless of whether doing so requires extraordinary persistence and patience. Because many of these patients, like children, are unable to care for or think for themselves, it becomes our duty as physicians to protect them from their own poor decision-making. For them we must employ a paternalistic model of medicine. Anything less, besides being immoral, would both compromise the integrity of our profession and erode the fabric of our society.

Yet, it happens from time to time that we encounter a patient who strikes some deep chord within ourselves, a patient whose disease ignites within us a powerful rage of indignation. Perhaps the patient is the mother of a medical student, or a physician herself; perhaps a high school teacher, a professional musician, a writer, or a social worker. Someone whose entire being radiates kindness, warmth, and understanding. For this person, we want to do more, to give more, to fight harder. But is it wrong to do so? Must we deny our desire to go above and beyond the call of duty in her care in order to make sure that we do not favor any particular patient? The answer, I think is no. To do so would be to deny one’s humanity, like passing on life-sustaining food when starving or holding back tears when they ache to be shed. No, I say, let us embrace our desire to nurture, to fight for the patient; let us play the favorite! Let us proofread her orders an extra time, search the literature for any new treatments of her condition, spend the time with her that we want and let her know that we care. Because by doing so, in addition to acknowledging our own humanity, we will learn what it means to be great physicians. And that knowledge is something that we will be able to use to elevate the care that we provide to all of our patients, no matter how beloved to us they are.