27/03 Kaleidoscope of the Heart: The line between patient and docto

Kaleidoscope of the Heart: The line between patient and doctor

I know a poet named Koji Tsukino. He presides over an expressionistic group where he reads aloud his own works in powerful performances. A requirement for being a member of that group, however, is having a physical or mental illness or disability that causes you to "struggle with life." Mr. Tsukino himself has struggled with and overcome alcoholism and neurosis.

Over the course of repeated visits to watch that group's performances, full as they are of both sorrow and joy, I have become hooked. I now associate with the members like we are friends. For instance, the other day I participated in an Internet radio program hosted by Mr. Tsukino.

However, until now, I tried to keep a personal distance between myself and those who might seek my professional advice. Even if I am not seeing them officially, I am a psychiatrist, and during training we have it hammered into us that if one casually associates with "patients," the relationship between doctor and patient will become warped. For example, if I were to go out for a meal with some of the members of Mr. Tsukino's group, and someone were to say that their personal doctor recommended such-and-such, and then ask what I think, I would have to decide whether to answer as a doctor or as a friend. In order to avoid such issues, I had decided that even outside of the hospital, I had better not get on too casual terms with potential patients.

Now, though, things are a little different. I feel that I've become better able to naturally respond to questions about treatment without worrying about whether to take the role of doctor or friend. If someone complained to me, "My doctor prescribes nothing but strong medicine," I think now I would be able to give a reply like, "Well, I think your doctor has their reasons for doing that. You know, things are hard for doctors, too. Why don't you try just frankly expressing your concerns to them?"

Meanwhile, during the Internet radio recording session with Mr. Tsukino, he told his stories of hardships in such a funny way that I couldn't help but laugh out loud. If I had kept a personal distance like until now, I might have worried that I had hurt his feelings by laughing, but instead I was able to feel that since we have gotten to know each other, it's OK to have laughed. And, if he had had his feelings hurt, I am sure that Mr. Tsukino would have been comfortable telling me so, and I would apologize in that case.

In the end, if there is a relationship of trust, then I don't think there is a reason to fuss over whether we are "doctor and patient" or "two friends." Still, it has taken me 25 years as a psychiatrist before coming to feel this way. Perhaps it is something that can only be understood after spending many years in this world. It makes me glad that I have continued this line of work. (By Rika Kayama, psychiatrist)

Click here for the original Japanese story

(Mainichi Japan) March 27, 2011