One could always say, "None of your G-D business," but these doctors are the ones who tend to have empty waiting rooms, and consequently feel none the better for it.

I'm a man of few words, having grown up as a child of few words. So, when you have this as a background, you do not necessarily feel the urge to respond when social niceties are going on. Silence sends a powerful message, and you find that when "How are you?" elicits no response, the question occurs less often, just as well, since the asker didn't really care anyway. There are the moments when, for example, caffeine levels approach toxic levels, that not only sundry mumbling and grunts may be emitted, but surprising verbosity even in response to questions directed at someone else. This, too, has the effect of reducing the likelihood of being included in any unimportant social niceties.

You, on the other hand, were perhaps raised by Chip N Dale, in which case conversations can develop something akin to perpetual motion:
"After you."
"Oh, by all means, after you."
"But I insist."
"No, I won't hear of it. After you."
"Please, be my guest."
"I couldn't possibly. Do proceed."

and so on.

Hey Dr. Rob!

Sounds like they ask cause they care and they can tell if you are a bit 'off'.

When I was a kid our family doc was a riot...always laughing...always kidding. But every now and then he would seem so sad. My dad once took him aside and asked if he was ok (keep in mind there were 5 kids and 2 adults in my family so we were frequent patients). The doc assured my dad things were 'just fine'. And 2 weeks later he killed himself.

While I totally understand your need to keep your private life private, at some point your patients will see right thru you..especially if they are frequent patients.

Rather than figuring out how to do the 'discretion dance' with your patients, take care of what is bumming you out.

We all care about you (duh, stating the obvious!!) even those of us that are relative newbies to your site.

:)

I feel that way when anyone asks me that question as a form of greeting, few people really want to know and they usually start talking about something else before you can answer, if you have a mind to, anyway.
Even a Hi, or Good Morniing, etc., is better.

Follow your heart, Rob, but if you have persistent thoughts about disclosing your concerns (urge-to-dump), it may mean you SHOULD disclose them--to someone. A professional? A trusted friend? A family member? A colleague? Your financial advisor?

Off topic but I just read your side bar. Pomegranate. That's funny! :)

"You shouldn’t expose your struggles if it does not help the other person or it does not really help you." I think you need a new measuring stick here. Hopefully, you only keep this with patients and not the others around you that care.

I agree with Dr. Gwen's statement about the boundaries. In our area, it is a rural area and at times, we are aware as patients, what our doctors are experiencing. We also have come to know them, as they do us, and we pick up on those times they are not themselves. We care about them, as they have cared for us.

That said, no patient should pry, should dog on you. I believe your patients truly care about you as a person, just from knowing what I do of you, but none of that gives anyone the right to try to force you to open up. I know you keep the balance.

oh crumbs Dr. Rob.

I am one of those clingy, barnacle-like patients who glom on and nevermind what is up with your life, my problems are all about me...

Except... YOU helped me a lot. YOU listened and you personally emailed and you were kind and you were real.

I wish I could say that about our local doctors but I can not.

Dr. Rob: You are GOLDEN... LOVE YA and by golly, if I could carry whatever cross is heavy on you I would. LET ME. But I have a feeling it is your own and personal burden...

Well... just want to say HEY JEEPERS DR. ROB: you make a huge and fine difference in the world. And whatever God you are believining in? God bless ya!

love from your big ol' pest,
tl

Ah. That is a tough situation. I'm guessing you practice in a smaller community? Do you think some of them might already know about your situation (if it's something that's out in the open in your private life) and be trying to "draw you out?"

Boy, that would make me uncomfortable 10 ways 'til Sunday ... ugh!

I'd probably deal with it with a little heart-to-heart- "Patient, I appreciate that you're worried about me. That means a lot to me, and I thank you for it. You're right, I've got a lot going on in my life right now. But, I'm also blessed to have excellent support, my friends and family have totally got my back. I appreciate that you want to help, but in order for me to help you with x,y,z medical issues, I just really need for us to focus on those medical problems right now. It's important to me that, even though things are rough for me, that I continue to deliver the standard of medical care I hold myself to. I appreciate your understanding."

Actually the problem I face is that some patients are dogged in their questioning. They act like it is their right to know details about my life. They know about my kids and about the other situations. If I share, then they are going to keep asking me.

Just as an aside - I was in the office late this week and shared a little with the housekeeping staff (explaining why I was there so late) and the lady said to me: 'if you need a shoulder to cry on, just let me know.' It was very sweet. I doubt I will take her up on it though.

I guess there is a need for personal space with my patients. I do like to some extent to not have myself all exposed to people unless needed. You shouldn't expose your struggles if it does not help the other person or it does not really help you. That is pretty much the measure I use, and with most of my patients it is to say something like: "fair to partly cloudy."

It just amazes me how many of them ask and persist in asking.

I find that patients want to know we are human but also want the focus to be on them. I usually say things like "I'm ok, thanks for asking" then turn the questioning back to the patient. If I'm feeling rushed or grumpy I usually find I'm running late! So, I'll often break the ice by saying "I'm sorry to be running late and seem to off today - been one of those days" and leave it at that. I find patients can tell when we are "off" and finding a way to name that in the room helps all of us.

The pain scale is a great approach, too!

Boundaries are important but we are human and I believe it is ok if our patients know we have "stuff" going on if it comes up or seems to make sense in the visit to drop. I've had colleagues say to patients "I'm sorry I'm off today - have a lot going on" or that sort of thing.

Hang in there - hopefully venting by the blog will help keep you focused.

I'm not a great liar either, so I'll usually go with something like "it's been a long few days, but I'm looking forward to ...." This works particularly well if the thing I can say I'm looking forward to is giving them some good news or hearing some good news from them (and, giving/hearing good news does truly pick me up). I think patients ask more me this question more, and with more intensity, when they sense something's wrong with me.

If I've got something bad enough happening in my life that it shows in my face despite my best efforts, I figure it's best to just acknowledge that I'm not doing so great, but that my distress has nothing to do with them and that I'm focused on their visit.

I agree with Bongi. It's tempting to share details with your patients, but it crosses the line. But don't be afraid to share with your friends... that's what we're here for. :)

So what do you do when you are out of the office and you run into a patient? As a patient, it's always hard to know if I should talk to my doctor if I see him out somewhere. I don't want to be rude, but I also don't want to make him uncomfortable. KWIM?

I will say that I am only somewhat transparent. There are times when it is helpful for the patient to see me as a normal person. I speak about my struggles with our teenagers and my ADHD as a child - it is helpful for people to hear about this. Yet I don't think it is good when my problems take the focus off the main point of the visit, which is the need of the patient. I don't ever want to talk about me so much that the patient forgets to tell me about their unexplained weight loss or coughing up blood. The patient is the reason for the encounter, not the doctor. Where I can help by being open, I will.

Thanks so much for the good suggestions and especially for the support.

CAK- I love the idea of using fractions in the pain scale. I hope I never have to again but if I do maybe I will go with something like 5 6/8ths....or 10 2/16ths... just for a little fun. ;)

Rob, why don't you (cleverly) use the 1-10 pain scale idiom: "On a scale of 1-10, I'm a 5 3/4" or something like that---it is just vague enough, a little disarming, it will make both of you smile, or look quizzical.

Or say that the 360-point decline in the NSE has you edgy. Or some other REALLY obscure news item---say from Zoo Knudsen's news roundup---has you scratching your head.

Or (now inching more towards honesty) you could say you could use a little more peace and goodwill in your life. Or whatever guise you choose to allude to the truth of your present condition.

Way-down-deep, I think you are talking about that moving target, professionalism. Other professionals besides doctors grapple with how personal they can be, how much to lower the boundaries, how much to disclose.

There is another concept, newish to medicine. It is transparency. I like the notion. I wish everyone would be more transparent in every way. Here is what I know: if I am transparent, I attract transparency. To me that means we are all moving together towards more honesty. I like that better than professionalism, if I had to choose.
C & V

Well, in the cases of SOME of my doctors, I really *do* care how they are. You develop relationships with your doctors, especially your GP's. My GP knew just about every aspect of my life except my sex life. He knew that I didn't have buckets of money when I came to him and complained that the Neurologist refused to prescribe me any medication I could afford (even with insurance), he knew about my weight problems and how they made me feel (PS: he never made me ashamed about it, which is one of the many reasons he has a warm and fuzzy place in my heart), he knew about my depression and WHY I was depressed. Patients know that our doctors don't exactly want to hang out with us after work, but it's sort of nice after all of the embarrassing, depressing things we have to tell them about our own lives if they give us SOMETHING personal.

For example, my beloved GP, Dr C, was having hip problems, so I'd ask him how he was feeling and if his hip was feeling better. I really cared about how he was feeling, and I think he knew that, so he'd kvetch and moan about his hip (like any human being would, because watching him hobble around made ME hurt) and it made him a real live person to me, rather than an automaton in a white coat. If he were having problems in his marriage, or had big gambling debts or a cough-syrup habit, I'll admit I'd feel uncomfortable if he told me about it, but it was SO, SO, SO nice to have something real from him rather than the standard "I'm doing well. How are YOU today?"

I think there's a way to do small talk, where you give away a little personal information, and it makes you into a real person, but you don't have to give everything away. For example, if you're cranky because you've just spent an hour on the phone to a big soulless insurance company begging for a procedure that a patient really needs, it's okay to say that you're cranky because you've been fighting The Man (and you don't have to say who The Man is if you don't want to, but everyone gets cranky, even doctors. And it makes them human). If you're cranky because your daughter joined a motorcycle gang, got a tattoo of a skull on her forehead and is dating a guy named Killer, that might be saved for one of the patients you have that kind of relationship with...does that make any sense at all?

It's just nice sometimes to see that my doctor is human and has human flaws and gets cranky and gets the sniffles or a bum back, just like I do.

i agree with you fully. patients are, on the whole, not your friends and there is a line that must not be crossed.

however, when patients ask that, i just see it as the normal cultural interaction and small talk. it is just an extended hello. i don't see it as a lie to follow the cultural que and answer 'fine' to the 'how are you' that follows the 'hello'.

It's an interesting topic. I work as a nurse practitioner and I think it's hard to strike a balance of acknowledging you are a person (not a health care robot) without shifting the focus from the purpose of the visit.

I wonder if you saw this article a few months back. I found it interesting. Basically, it appears that health care provides may overestimate how interested our patients are in us personally.

http://www.usatoday.com/news/health/2007-06-25-...

I think it would be hard to define, sometimes, the relationship between doctor and patient. I imagine it would be very difficult, when your life outside of your workplace is not fantastic, to brush that off when people are genuinely concerned.

As a midwife, one of the first things I am asked is if I have children. When I am working with ladies who are experiencing stillbirth, it effects me differently, having experienced neonatal death. Sometimes providing care IS personal.

I always like to know how our paed is going. Whether you give anything away or not, how you are really feeling must reflect in your practice in some way. The people who are asking could be picking up something in your voice or in body language. You're only human.

With our paed, his emotional wellbeing certainly reflects on how chatty he is, how focused he is and how much information he relays without prompts. For example; his wife is due to have their forth child sometime this month and, even though he says he is good, he comes across as stressed and pre ocupied (understandably). We certainly don't expect him to be perfectly happy every time we see him. That would be unrealistic.
I prefer it when he is open and upfront, so that we all know where we stand before the appointment begins.

One thing you have to remeber is that in a very personal way, your patients are opening themselves up to you. You know things about them that even their spouses may not know. So, in a way, their interest in your problems is natural.

You need not expose your problems to patients. It's really not their business.

It may be hard, but sometimes it's best just to try to smile and let it go at that.

My mind has gone suddenly blank as to my many answers to this question.

Some of them are 'status quo'
'Same ol' same ol' '
Some times, I totally ignore the question and turn it back on them and say "how are you today?"

Many ask me, they care, they really do. But if I answered it, truthfully everytime I was asked ... it would depress me!

I prefer to creatively answer the question so that they don't know they've had the answer skirted.

I hate the question 'how are you' when it is used as a greeting.

As a caring patient toward her doctors...I understand both sides. My PCP has shared stuff as seemed appropriate..say like if it tied in to something going on with me. We have also shared spiritual things. But the saddest thing by far and it was all over his countenance, was his mother coming home to be set up with hospice last February. He wouldn't have volunteered it but I had to ask and it spilled out. I could see he wanted to leave and I ended it quickly (not usual for me) and I just leaned in and gave him a warm hug to which he hugged back. I know he was moved by that. And I am glad I hugged him because hugs can convey more than words.

Some patients are being polite and some really care. I would think if you did answer with the truth it might take the focus off the pt and then cause an extended visit that would back you up. Then again Dr Rob maybe there are exceptions. maybe you and other medical professionals would vehemently disagree with me but I do think that there are times God has allowed certain people to be in our lives at just the right time and it might even be a patient making a positive difference in a doctor's life even though it is supposed to be the other way around. We're all human and I think our paths cross for a reason even though it might not be obvious as to why.

My PCP using self disclosure when it tied into my personal concerns has helped me many times over the years and strengthened my bond with him, even though I hardly see him. Conversely my urodoc has never self disclosed anything of significance, and just a few little things in the almost two years I have known him and yet I am just as bonded to him as I am to my PCP, perhaps even more so because of the frequency and severity of things that were going on and of course he has been amazing with me in many, many ways. He broke his foot this past spring (he did mention that in a phone conversation with me because it tied into something) and when I next saw him in the office and sincerely inquired he brushed it off and said fine and then the appointment was all about me.

I like you have a good support system of loving family and friends who mean the world to me. I care just as much about both doctors as if they were in my inner circle and would be devastated if anything ever happened to them. So I am one of those patients who genuinely cares but can see where boundaries could get confused.

Life isn't black and white although maybe what you learned in med school is as far as ethics but I still think there is a lot of gray in between and comes down to a judgment call. How many of us "lie" and say we are "fine" when we are not? There is a time and a place or to everything there is a season for these things. you are not divulging your feelings (when you might want to)because of your goal for the greater good in the encounter.

You know what is hard for me as a patient that has bonded with her docs. They do feel like friends. Intellectually I know they are not. I know them as they present in the office or hospital settings. I do not know their favorite colors, foods, music or even bad habits...you know the kinds of things you know about your real friends. It's weird..like I have a friend who's not my friend. So as a caring patient (they don't know I do this) I pray for them, their families their practice, all staff and patients that they will be blessed and be a blessing. Just a general prayer sent their way every now and then.

I am sorry this is so long or if off track. Please delete if you wish. :)

Ha! For the 1st time I remembered to do the spam number! Now..I am going to hit submit. :)

Hopefully it will be true soon.

(((hugs))))