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GUEST POST: The Finest Gifts: Finding Balance and Relationships in Pediatrics – A Junior Resident Perspective

Friday, March 22, 2013

Pediatric resident Dr. Shazeen Suleman writes:

Last month, I was surprised with a gift from a family I had cared for. On a day I had felt particularly beaten down, it was a wonderful reminder of the appreciation of many families. The card still sits on my fridge, so I can read the words daily, as does a plastic bracelet with the name of the patient and “Together We Can.”

However, one part of the gift remains unopened.

In addition to the lovely, heartfelt card and symbol of strength and hope, this particular family had generously given me a beautiful crystal piece of jewelry. I didn’t have the opportunity to even express my thanks in person – the family had simply left gifts for all the staff who had helped them at the main nursing station on a particular ward.

In speaking with a mentor earlier this week, I realized why I hadn’t opened that part of the gift: it felt uncomfortable. To dissect why I – and I’m sure many other residents – may feel this way requires a bit of an exploration into navigating relationships in medicine, particularly when in training. In particular, it seems to be of greater issue in pediatric medicine than other specialties, again highlighting some of the specific challenges we face.

As a medical student, I loved being able to be the “frontline” staff member, the person who spent the most amount of time with a patient and their family. This was partly due to the fact that it took me a lot longer to get through a history and physical for complex problems, and also partly due to the fewer other responsibilities I had. In spending time with families, our relationships grew; we would often be the team members who would uncover the crucial, “non-medical” psychosocial elements that contributed significantly to their treatment and recovery. It was empowering to both myself and the patient to have an open, trusting relationship and for very this reason, relationships are a central tenet in social pediatrics, recognizing that for the most vulnerable, trust is essential for providing good care.

In July, I began my pediatrics residency at a large tertiary center in Canada, and again often found myself as the most junior member of my team. Whether on the general pediatrics ward or in the NICU, I often spent hours talking to patients and their families about their concerns, fears and interests. However – I wasn’t just their student now, I was their doctor. I wrote their prescriptions, made their referrals, went over their discharge instructions, and counseled them on home management. Our relationships often grew even closer and sometimes, the doctor-patient boundary felt more like a line in the sand. Parents often ask me where I went to medical school, when I’d be finished with my residency, what I’m planning to do. These friendly questions were what confused me; instead of their doctor, I sometimes felt like their friend.

Relationships help you advocate for, empower, and care for your patients. However, they can also negatively affect you and the care you provide. In medical school, I remember learning about transference and counter-transference. Transference is what happens when you feel the emotions from your patient, for example, if a patient reminds you of your friend or family member.  Countertransference is what happens when your feelings then dictate how you feel toward the patient. This might mean feeling happy around certain patients and dreading seeing others. It might even be the sadness you experience when something negative happens to a patient you were caring for, that you carry home with you. Gifts are another manifestation of countertransference and transference, representing emotion in tangible form which in turn, affects your relationship with your patient. In a world where we must still be able to provide objective care for those around us, countertransference and transference are challenges that we as junior medical team members may often struggle with the most, particularly since we are the ones that spend the most time with the patients and families.

My greater challenge now is managing these relationships and how they affect me. I love knowing that I’ve been able to connect with my patients’ families on a meaningful level, that they know how sincerely I care for them. However, I need to be able to manage the emotions that come with that and balance my feelings with the professional values of objectivity and equality. As a junior resident, it’s been helpful to know that I’m not alone; senior residents, fellows and staff have all had similar experiences. Any time colleagues share a particular clinical encounter, they’re sharing a relationship with you and the impact it had. By reflecting on my emotions and actions individually and with my peers, I’m better able to understand myself and my own emotional needs, and in turn, continue to provide my patients with my whole attention without compromise.

My unopened gift remains in its box. The family had already gifted me with something much more valuable: a meaningful relationship and the validation that care, concern and connection have so much impact on our patient’s lives. Equally important, they have helped me realize that there is a fine balance between connecting and professionalism, as giving too much of myself can conversely negatively affect my patients. In the end, I strive to constantly reflect on how I feel so that I can strike this careful balance, and advocate for my patients.

ABOUT OUR GUEST POST CONTRIBUTOR: Shazeen is a first year pediatrics resident in Toronto, Ontario, Canada. She has a strong interest in medical education, reflective practice, social pediatrics and early childhood development. For more, you can follow her on Twitter @shazeen_s.


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