The Family Physician – Patient Relationship from a Covenantal Viewpoint
Originally published March 2014
My Collins English Dictionary defines a covenant as “a binding agreement, a contract.” I have never had such an arrangement with my patients. The closest approach to this was “the Hippocratic Oath” which was recited at my graduation. Nevertheless, there were/are unwritten expectations.
The relationship between family physicians and their patients is based on trust – there is an expectation that besides doing the patient no harm, you will be an active advocate for him/her, that you will not use your position of power to take advantage of him/her. There should never be a “quid pro quo” relationship between you – that is “I am doing this for you, so you can do this for me.” Doctors can be tempted to take advantage of the power gap between them and their patients. This is probably a major reason why a Christian physician should have someone to whom he/she is accountable. From my experience, I think that a group practice setting helps with setting boundaries. Boundaries should also be set between a doctor and his staff too. This is an area where Christian patients can pray for their doctors! The ante is upped a bit, in all aspects of your practice, when you claim to be a Christian, though medicine in its purist form is essentially a Christian activity. I am leery of those who specifically choose a doctor because the doctor is a Christian. My antennae go up! I wonder if their expectations are greater than I can deliver.
There is a reasonable expectation that you will keep up to date. This is difficult for the family physician, as there is a large range of topics to know about. After a long and challenging day at work, there isn’t much enthusiasm for reading, especially when your family is young and children have to be conveyed to different events. Nonetheless, continuing medical education is necessary.
Your spouse is your greatest ally; she/he needs to be nurtured! I believe that family physicians, for the benefit of their patients as well as themselves, should spend time in recreation and take adequate holidays for at least a month a year! The Lord doesn’t call us to be workaholics. Freshness lends itself to new insights.
Let’s look at specific instances of the family doctor/patient relationship. Should the Christian physician be a servant or a slave to his patients? I always regarded myself as being a servant, but recent teaching at church said we should be love-slaves of Christ, but He is a totally trustworthy Lord. I’m not sure the same applies in our relationship with our patients. As their servant, I should go the extra mile for them, but should not succumb and become patient pleasers. We have to be able to say ”No.”
Should Christian physicians pray with or witness to patients? This is another area where the power imbalance might manifest itself. There were definite times when I felt the prompting of the Holy Spirit to pray with patients after respectfully asking and obtaining their permission. This is doubly beneficial when you have a nurse who is also a committed Christian, who can share in the prayer. In relation to this I recommend the book: Gray Matter: A Neurosurgeon Discovers the Power of Prayer . . . One Patient at a Time by Dr. David Levy.
I have never witnessed to patients. I have told some that their burdens would be lighter if they were able to commit themselves to the Lord but this was dependent on where they were at spiritually. Upon reflection, as I near retirement, I realize that I should have done this more often. There are patients who will never meet another Christian. The literature shows that greater than 50% of palliative care patients want their doctor to raise the issue of spiritual matters.
Patient advocacy should mean really going to bat for your patients. The various provincial workplace safety or compensation boards and insurance plans in general, do not want to spend a dime on patients. Document your patient’s disability conscientiously and fight for them! Most patients want to work. Those who don’t are relatively rare and are not too difficult to diagnose because of their noncompliance.
These are a few reflections that I hope will provide food for thought. Doubtless you could add more to this discussion. For the Christian, relationship with one’s patients is really just part of the continuum of all one’s relationships, in which the prime motivator should be to reflect Jesus.