January 3, 2012

A woman I met at a Christmas party asked me, "What's your incentive?" If your patients get better, she continued, you'll lose business. She was an accountant, of course. "I hope all my patients do put me out of business," I replied. She was aghast. I guess I don't see the world through accountant eyes. "Well, there are always more people who need help," I said. That satisfied her a little more, but her eyes seemed to say, "I guess so, but I don't really trust anyone who makes money off misery. They will just want to keep people miserable." I don't know what she thinks of other kinds of doctors. Did she think a surgeon's only incentive is to avoid being sued? Or is it only mental health professionals she mistrusts?

What's my incentive? Well, I do what I do because I want to help people get better. It turns out, that's not as easy as it might sound. I have to work hard at understanding myself and others on all dimensions of health and wellness - biological, psychological, social, cultural and spiritual. I have to keep working on my toolbox, my "skillful means", of how to interact with patients. Sometimes I have to be comfortable with not knowing. Mark Epstein quotes Emmanuel Ghent in his book Psychotherapy Without a Self: "what other occupation has built into it the frustration of feeling helpless, stupid and lost as a necessary part of the work? And what other occupation puts its practitioners in the position of being an onlooker or midwife to the fulfillment of others' destinies?...In a sense it is the portrait of a masochist."

Well, I'm no glutton for punishment, but my profession teaches me humility in the face of another person's experience and suffering. I don't completely "surrender" to their suffering, as Ghent suggested later in that passage, I think, because I must remain objective even as I become deeply related to them. If I want to help them, I have to work on their suffering from a position of health, wholeness, and a certain amount of detachment or neutrality. Yet at the same time I have to engage with their self-, other- and worldviews completely. This is a fruitful endeavor, and I learn tremendously from my patients even as I seek to help them. I think every therapist knows that their patients change them, too, in the process of therapy. I think I'm a deeper, more compassionate, wise and thorough professional in large part because of my patients. That's the biggest incentive I could ask for. That I get paid for it is a necessary condition of the work.

Accountants are part of life - and not all accountants are the same - but I hope that more people this year will look at the bigger picture. If the world puts doctors, lawyers, politicians, financiers, accountants etc. out of business (because we're all healthy, wealthy and wise), I would be extremely happy. Until then, I'm at your service!

Happy New Year, everyone!

UPDATE:  A friend and mentor remarked - "If she had asked me, I would have just said 'love'!"  Indeed, that's exactly it.  What a concept!

©  2012 Ravi Chandra, M.D. All rights reserved.  

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