A glimpse into today’s media is enough to understand the general attitude of modern medicine and health care. While the majority of the population regards scientific progress as a blessing, a not-so-small minority is fearful of how this will negatively impact their health. It seems that they regard themselves as the left-behinds and the forgotten ones in the capitalistic world of evidence-based medicine. “Doctors don’t listen to us anymore!” and “Medicine is just a business!” are common complaints of this group. These patients tend to split medicine regularly into good and evil. On the one hand is the bad, scientific, money-making machine, which disregards people’s emotions and humanism needed for quality medicine. The good medicine, on the other hand, with thoughtful alternative practitioners, essential oils and mindfulness, neglects this “inhumane” and all too rational evidence-based approach.
Deep down we doctors tend to devalue these patients. Their seemingly irrational remarks threaten our existence. Often, I have heard my fellow classmates talk about these patients in a demeaning way, insulting their intellect and level of education. However, this is not the problem. Rather, it is the patients’ underlying emotional quality. Though devaluation is the wrong approach, the strategy is understandable. It reveals a core problem in medicine and among students and doctors: The neglect of emotions in medical school curricula around the world.
Relationships are part of our life from the earliest start. A child’s relationship to his parents has a positive effect on his or her health and well-being. Children who were nurtured are less often sick, succeed more in later life and suffer less from chronic disease. Epigenetics shows us that even our genetic expression changes in the light of our life’s circumstances and choices.
Renowned physician and psychoanalyst Michael Balint famously stated that the strongest drug prescribed is our relationship with the patient. As we go through our medical education, we face different patients. Some are difficult, some are kind and some we quickly forget about. A strong patient-doctor relationship forms a necessary foundation for patients’ well-being and recovery. In both inpatient and outpatient settings, this relationship is often neglected. Sadly, we lack the time due to the extremely high number of patients we must see each day. But, generally, the positive impact of this relationships in health care is denied.
We as adults forget our early relationships and, yet, we continue to seek similar nurturing and appreciation in our romantic relationships.
Romantic relationships are a tricky thing. We long for comfort and safety, want to give back and receive and often want to be understood without words. Repeatedly, we regress to a younger version of ourselves and expect our lover to understand our emotions and desires without having to verbalize them. We know that this behavior is irrational, but it feels like a defeat when we have to verbalize our inner world. The emotional, nonverbal understanding is at the core of Romanticism. According to Alain de Botton, Romanticism is a philosophy of intuitive agreement. This late 18th century philosophy is not only evident in our relationships, but also in our daily medical practice.
Like lovers in a relationship, the Romantic Patients expect to be understood intuitively. Emotions are inevitably connected to illness and it is not easy to live with or speak about guilt, anxiety, sadness or shame. At the same time, emotional distress can cause functional symptoms. Psychodynamic theory teaches us that it is easier to acknowledge a functional symptom than an emotional conflict threatening our ego.
We are lucky most patients have insight into their inner world and allow themselves to talk about it. Yet, the aforementioned minority is incapable of this, and thus, is the Romantic Patient.
Romantic Patients primarily seek for a deeper relationship and want to be understood intuitively. Similar to partners feeling neglected by their lover, Romantic Patients feel neglected by their doctors. As we all try to protect our ego and self-worth, they turn to defense mechanisms in order to conceal this emotional world. These mechanisms include denial, repression, displacement and splitting. First, they deny or repress the inner conflict and afterwards they continue to split medicine into good and bad to avoid disappointment. Because the Romantic Patient often needs the emotional connection more than physical medicine, he or she will turn to alternative practitioners who offer this precise quality disguised as herbal, side-effect-free medicine. Their threatened ego is tricked into recovery by the ultimate non-threatening remedy. Alternative medicine is used to displace their longing for a parent-like support.
As practitioners, we sometimes feel helpless as well. This may impact the way we practice. For example, antibiotics are overprescribed and one might wonder if doctors feel more comfort in prescribing them than the patient receives from taking them.
What can we do to help these people? First, we need to recognize our own inner world. We fear the Romantic Patient because it is a challenge to give to those who need it the most. Often, the fear and helplessness we feel in these moments is the (emotional) transference of the patient. In the end, perhaps the most important question to ask these patients is, “How do you feel with your illness?“