Comments on: Boundary Issues: A Doctor With MS Confides In Her Patient

By: Julie

Julie — Sun, 07 Feb 2010 19:55:59 +0000

I think you definitely did the right thing. I wouldn’t call it confiding, I’d call it just plain doing the right thing, professionally and personally. Someone who gets bad news from a doctor knows that the doctor does not want to give the news (sometimes so much so that they actually do not give the news- hard to believe, but I’ve seen this) and wants to reassure the patient that everything will be ok, even if it will not, if only to disengage from the uncomfortable role of being the bearer of bad news, and end the interaction as cleanly as possible, sometimes for the sake of their own sanity. Especially in cases where the etiology of the illness is not understood and there is no cure, clear prognosis or reliable treatment, hearing from a fellow sufferer is very comforting, as any other sufferer is as much an authority on the topic at hand as anybody else on the planet, more so because they speak from actual personal experience. The patient is in a place where science can’t really reach them, but they can be reached by a human being who offers spiritual comfort and lets them know in no uncertain terms that they are not alone. Your own suffering was not wasted because you used it to help another person, and I think that withholding this personal information under these circumstances would be unconscionable, really, and could have had grave consequences. It’s hard to know the state of mind of the person receiving the news; God forbid you should ever have to look back and say, ”If only I had said something about my personal experience, the person might have taken the news better and still be with us”. You did a very brave thing by telling her, and it is good to know that there are people like you out there. Thank you.

By: When Doctors Confide in Patients « Eric Legras … THEDOCTORFACTORY … Health & Wellness Strategic Marketing

Fri, 30 Oct 2009 11:32:41 +0000

[...] go to CommonHealth on WBUR, a National Public Radio station in Boston, to read her full essay, “Boundary Issues: A Doctor With M.S. Confides in Her Patient,” and then please join the discussion below. Do you agree with Dr. Brewster’s decision to [...]

By: Jim deMaine, MD

Jim deMaine, MD — Wed, 28 Oct 2009 16:26:22 +0000

Thanks for discussing this issue. During my 30+ year practice in Pulmonary/Critical Care Medicine, I gradually became more comfortable using personal information for two main reasons: to show that I cared in a special way, and to help teach and mentor the patient in a story format. When discussing withdrawal from a ventilator I might bring up my mother’s death and how difficult the decision was. If a patient had sarcoidosis and was particularly worried, I might reveal that I had it too (true!) and how I decided whether to treat or not.

In medical school a professor brought in a patient for teaching purposes one day and said: “Students, I have a very interesting case to present.” Then he paused and said, “I’ve just made two significant mistakes, what were they?” After discussion he explained, “Labeling a person as a patient can make them feel like an object. Remember, that’s a person you’re caring for. Secondly, by calling them interesting, you’re focusing on the disease not the whole person.”

I think you addressed the concern of boundaries well. It needs to be the right person, the right setting, and the right amount of information sharing. With maturity and common sense, I think physicians should explore sharing more with patients.

Growing up in a small town with a GP father, all of his patients knew everything about our family. So the sharing of information issue was moot and didn’t interfere with a very satisfying practice.

By: Harriet,LISW

Harriet,LISW — Mon, 26 Oct 2009 20:25:09 +0000

Thanks Annie for your sharing. As a Social Worker who works with the elderly, I wish more doctors would show empathy. Wishes for peace and good health.

By: john lipkin

john lipkin — Mon, 26 Oct 2009 12:29:52 +0000

Well done Dr. Brewster. But all of us physicians should remember that we will all be patients from time to time. We will.. sooner or later.. all have personal experiences which can help our patients. Failing to share them should not be justified under the misleading label of “professionalism”. Proper professional boundaries are important, but they do not require robot like behavior by doctors.
There are always personal things that should not be shared. There are sometimes patients who should not be trusted with personal facts about their providers.
Even in fields like psychiatry, some sharing can be useful and humane.

By: Lucy Keefe

Lucy Keefe — Mon, 26 Oct 2009 02:11:21 +0000

Bravo, Annie. And beautifully done.

By: Joyce

Joyce — Sun, 25 Oct 2009 16:49:39 +0000

Anne, you touched on a topic I grapple with frequently. I provide cognitive therapy to people suffering from various brain diseases, Lupus, MS, Seizure disorders, Brain tumors, and a host of others. We focus on strategies to facilitate or compensate for weaknesses in memory, attention, and processing of information, to enable people to function in their personal lives and often their professional ones as well. Although I do not have a similar disorder, I will sometimes decide to share other pieces of personal information when appropriate. It might be as simple as pointing out cognitive faux pas that I, like all of us, have made. Or, perhaps to share that I have a child with significant learning issues when the patient is dealing with this as well. My purpose is never to share as a way of saying, “You’re not the only one hurting”, but to create a therapeutic alliance that allows for an exchange of human caring and trust. It allows my patients to see me as “real” and that I do not have a power over them in my role as their clinician. Thank you Anne for your courage and honesty in sharing.

By: Mitchell West, DO, MHA

Mitchell West, DO, MHA — Sun, 25 Oct 2009 03:10:49 +0000

I don’t understand how you could question yourself about “crossing the line”. We are all people, whether we practice medicine or not. You responded as a compassionate human being whose sole intent was to relieve someone else’s pain and suffering. When it’s appropriate, I tell my patient’s that I’m a recovering addict and I have never regrettes doing so.

By: Cathy Wilkinson Barash

Cathy Wilkinson Barash — Sat, 24 Oct 2009 21:21:11 +0000

When the neurologist who diagnosed me with MS called (the night before Thanksgiving after months of all doctors saying they were sure I did not have MS), he said that I had MS, there was no treatment (back in 1984) and I should make monthly appointments to come see him so he could “chart my decline.” How different it would have been to have a doctor who could understand. Especially with a disease like MS that presents itself, and the course of the disease so differently from person to person. The diagnosis itself is enough to add so much stress as to bring on an exacerbation (as it has done with many folks I have talked with over the years).

Imagine, instead having a doctor like yourself who can truly relate to the questions and concerns—and general panic that can set in when those two fateful words, Multiple Sclerosis, are uttered. Bravo for your courage to do that and help your patient over a huge hurdle! the only line you crossed in my book was that of becoming a caring doctor, not just a clinician. Keep up the great work, and like all of us with MS – I wish you good health.

By: eric

eric — Sat, 24 Oct 2009 19:29:57 +0000

I don’t know much about proper doctor/patient protocol, but I am an ethics professor. Dr.Brewster’s sharing information about her own illness with her patient strikes me as being not only ethical but also highly laudatory. Dr. Brewster’s purpose was clearly to provide solace to the patient in as empathetic manner as possible; it would have been a mistake if she wanted to reverse roles and use the patient for her own benefit.