#medtwitter When a new patient tells you, only you have asked the right questions, only you are the humanistic health care provider: a) be a bit proud; b) but not that proud; & c) be aware of a sign of either-or, friend/foe thinking, common in survivors of chronic trauma. /1

You don't need to label this as "splitting", throw away your humanism medal and embrace the cruel colleague writing stigmatizing things in the chart, or proclaim yourself as the hospital hero who must teach everyone else how to listen to patients. You can just... listen more. /2

This is a challenging moment b/c the patient is talking about you, which gives you feelings of your own; but they _don't actually know you_. They're talking about how they feel right now, how they feel distrustful in the health setting, and are looking for an ally. /3

They're really not telling you something--they're asking you for something. They're asking you: be my unyielding ally. And if you respond too strongly to this praise, you're affirming that you will be this ally--when you don't know yet that you in fact will be. /4

You don't know yet what terms the patient is setting for this alliance. Does it mean, you listen to me and acknowledge me as a human? (Got it, can keep doing that) Or does it mean, and thus I think you might be the one who finally doses my benzos the way they should be? /5

Say all the humanistic harm reduction stuff you want on Twitter, at some point you are very likely to show that you're more doctor than friend. You hold power, given by the State, to deny interventions like medications, hospitalizations, etc; & sometimes the power to insist. /6

For better and for worse, maybe more for worse, being a doctor means exercising that power. Holding power ethically means being full of humility about the fact that your power means you sometimes will make people--especially wounded people desperate for an ally--feel betrayed. /7

There are lots of ways to get through these differences between doctor and patient and come out the other end with an alliance intact--humanistic respect for autonomy being first among them. But making yourself the hero at the start of the story is dangerous to the patient. /8

Rather than a sign that you have liberated yrself of power dynamics of medicine, heroism is a sign that you have cloaked yourself in them. You're telling the patient: I will be your hero. Which is a false hope which will cloud their ability to see your power for what it is. /9

The humanist hero is dangerous b/c what the patient is saying when they say you're a hero, is, I need you not to abandon me. But what they MOST need is a space where, when the two of you disagree later, it's not abandonment. Where they can use their power to wrestle w yours. /10

So, when someone says to a doctor, only *you* listen to me, only *you* are the healthcare provider who cares--what they're saying is, I am scared. I feel that I have no power within healthcare. Please replace that powerlessness with your power. Be my protector. /11

An ethical and democratic doctor responds to patients' fear and powerlessness by asking, how can I help you be your own protector? How can I help you find your own power? And, I'm not saying I always know how to do that. But I feel confident that's the goal. /fin