Expectations.

"Reflective practitioners can identify and interpret their own emotional responses..., can make sense of their own life journeys, and so can grant what is called for - and called forth..." Rita Charon (2001) Journal of the American Medical Academy 286(15):1899

I saw (a version of) this quote and was immediately inspired to write, consistent with one of my 2009 new life policies that I indulge (most of) these inspirations when they strike. Sometimes I'll write on Spintastic; sometimes I'll write here. But I will write. To kick things off in my epic New Year's post on Spintastic, I actually outlined -- more for myself than for either audience -- the difference between the content and style of the two blogs: here, there are no rules. I don't need to be articulate, or even literate. I can be outright psychotic if I want to. I have permission to rant and rave and tell anticlimactic stories. Spintastic, some people look to for inspiration -- and there is a certain pressure associated with that. No pressure, no expectations here. Just "identifying and interpreting (my) own emotional responses.... making sense of (my) own life journey" -- so as to, one day, be able to call up those responses and clarity when I need them.

I've been spending some time lately with a new character, which has prompted me to think about the art of self-presentation. I enjoy meeting new people -- people are fascinating and, accordingly, so is finding out what makes them tick. However, I have never enjoyed the process of people getting to know me. It's a lot of pressure - the strategic task of actively selecting the details and stories that most accurately paint a picture of what it is that makes me "me." I wish everything could just be KNOWN: everything I've seen, everything I've thought about, everything that's important to me. That's not how it works, of course. I find myself now sharing some thoughts that weren't very strategic at all -- that may or may not have actually achieved the desired effect. I was okay with that, okay with letting it all unfold. I had all the time in the world -- and if it didn't unfold in a way that was stimulating and compelling to me, so be it.

Today, I appreciated how different a first-time encounter is when it takes place in an examination room and not a coffee shop.

Everything's different: the goals, the rules, the expectations.

One would assume that the clear distinction is that doctor/patient relationships differ in the goals - from a mutual "get to know one another" to a one-sided "doctor get to know what's wrong with patient." I don't buy it. So much is variable...

I am wired to aim to understand the person before me -- what makes him or her tick, what goes on in the world outside this exam room (and I am lucky to be training in a program that prides itself on this same orientation). I am wired to aim to form a partnership, a "team effort" to build this complex and complete understanding as the backdrop of all the conventional "medical stuff." Many patients, especially younger and educated people, are all for it. They strive to be empowered in all realms of their life and, the way they see it, their health care should be no different. Damned straight. But so many people reject this construct -- whether that be because they outsource all the other aspects of their lives and automatically default to that option, have a distorted view of the "wise and mighty" doctor in the white coat, don't think they have the capacity to play a proactive role in their care, etc.

Many people also auto-filter the aspects of their lives that are "relevant." So right there, that one-sided "get to know you" goal is not as clear as one would think. It's not, "Here I am." as much as "Here's-the-part-of-me-I-think-you'll-find-relevant."

Conversely, the same principles and techniques developed for dealing with these challenges in clinical medicine do lend themselves nicely to casual interpersonal encounters. Altering the expectations, embracing the blankness of the slate... resolving to be ok with being unresolved.

I started this a week ago and don't remember where I was going with this. But maybe that's the point.