My lapse in judgment

It was early into my first clinical year and I was still being eager, traipsing up into the wards and asking for patients who would want to have a chat with me. A young gentleman was recommended, so I tiptoed into the shared room he was in.

He was on the far side of the room, and with the separating curtains in place by the time I could see him I was already in front of his bed and had made eye contact. And by eye contact I genuinely mean in its singular form, for he was missing an eye. I had no prior knowledge of his story so reminded myself not to react or make a point to highlight it, but truth be told I was taken aback ever so slightly. It was not because it bothered me, it was just something I had never encountered before. I wondered whether it was rude to only look at his one eye whilst talking, or if I should shift my eye contact between that and the empty space where the other would have existed, just like if I was conversing with someone who had two eyes. In hindsight it was a pretty trivial thing to be worried about, but for a fresh medical student who was only a month or two into her first clinical rotation it seemed important. Being overly conscious of patients’ conditions and disabilities is still a problem I struggle with, and there is a fine line that exists between acknowledging and respecting their difficulties, and overcompensating to the point of being insulting. Entering a conversation with the conscious effort of trying to create a sense of normalcy and making someone feel comfortable whilst simultaneously venturing into a thorough history of their past takes finesse. I am still stumbling my way through it and can only hope I have never unintentionally offended anyone.

So, I still haven’t addressed why the title alludes to a moral mistake on my behalf. We had a very long conversation and whilst I cannot remember exactly all that was said I can remember how it felt. It felt nice. We were of a similar age, so conversation flowed freely with no generational gap or sense of distance. We empathised with each other, and I shared almost as much of my life as he did. It was not a doctor-patient relationship, it wasn’t even a medical student-patient relationship. At the end of the day it felt like I had made a new friend and I think he felt so too. Because then came the oh so dangerous question, “Can I add you on Facebook?”

It may not seem like a big deal to many people, what’s in a friend request? It was an innocuous question, meant to consolidate our budding friendship and a symbol of the connection we made. The only problem is, it complicates what should strictly be a professional relationship. Clinican-patient distance is an important feature of the job designed to protect both parties. It creates barriers that allows the focus to be on providing good healthcare without letting other confounding factors to infiltrate. It is why many doctors choose to utilise pseudonyms on their social media accounts or keep their accounts vague, in order to make it harder to find. Being friendly is not the same as being friends, and although it may sound harsh and uncaring it is vital to being a good doctor.

Once a label of friendship has been implied it is easy to feel the pressure of certain obligations that can muddy a previously clear-cut relationship. The patient may now view certain services as a given, or expect extra effort the doctor may not usually provide. The doctor may have an emotional attachment that clouds their clinical judgment, or feel certain pressures to perform. Consultations may occur outside clinic hours in informal environments, without a documentation of notes to be legally utilised as evidence if needed. The patient’s perspective of the doctor’s professionalism may be unduly affected by what they see of their social lives. Or finally, it might just be awkward. Imaging your best mate knowing all of your embarrassing medical anomalies and vulnerabilities.

And so I added him on Facebook. Huh, you’re thinking, all that preaching and you turn out to be a complete hypocrite. I know I know, not the best confession to admit to. Part of the reason we were even in that situation was likely because I was so friendly and voluntarily shared my own stories. I had even thought to myself, if we hadn’t met in such circumstances it would be nice to be friends. So it shouldn’t come as a surprise how hard it is to reject such requests, particularly for someone who is so inexperienced dealing with these uncomfortable interactions.

In that moment I was wholly unprepared to be faced with such a question, so in a state of panic and to avoid ruining a great conversation with harsh rejection I agreed. Twenty seconds later, profiles had been shared and friends were made. I walked out feeling a little uneasy, but assured myself it was a harmless action and that I would face no repercussions. And I haven’t. To this day we remain background Facebook friends, never having spoken or interacted again. It is exactly the same as many other acquaintances I have on my account, aware of each others existence and sometimes an acknowledgement of the relationship through a “like,” but nothing more. It is a perfect example of how it is more likely for people to be genuinely friendly than to have ulterior motives behind their advances, but then where do you draw the line? How do you know where your relationship with someone is going to end up? Chances are they themselves may not have even thought about it and neither of you have considered intentionally letting it affect the professional relationship. You never know until it happens, and that’s the scary part. An innocent relationship can quickly turn sour, so for the sake of preventing the minority it is just easier to remain steadfast in your resolution.

It is even harder when your life-long family and friends seek advice. I know of doctors who remain unmoved, and kindly ask their friends to arrange a formal consult at their clinic. Which is definitely the right thing to do, especially if it is not a simple question. I haven’t had to confront such situations and am undecided how I would precisely phrase such a response, but I’d like to hope I’d be able to handle it or at least know where to refer them. I am worried about what happens if my parents need medical care, and how difficult it might be for me to stand back and allow experts to take control without trying to micromanage each step of the way. But we will cross that bridge when we come to it. For now I am going to work on maintaining my distance, which remember is not about being cold and unfeeling, but feeling enough to know what is best.