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The right fix

Do we have to ‘fix’ all our patients or are we a part of a process?

A man and his son came to see me once and I noticed two competing voices in my head. The son was suffering from anxiety, said the dad. The son was more reticent, at first.

I very quickly became aware of my personal and therapeutic dilemmas. Do I let dad lead in speaking or try to gently silence him and give space for his son, a legal adult, to speak? If this went wrong, I might silence the son. I might insult the dad.

How was I to cope with time management in a busy surgery? Could he be suicidal? How could I be sure?

As we proceeded, I hinted to dad that I needed his viewpoint but I was really interested in his son’s story from his own mouth, as told and described by himself. Dad was really great and soon offered to leave the room so that his son could have space alone with me.

The boy-adult opened up and we covered some ground in a short time. Anxiety and social insecurity were linked. I thought of my own social anxieties and my belief that everyone has some level of social anxiety in one situation or other.

I wanted him to guess that anxiety is a normal part of this learning process. Anxiety is not a sign that he is different or unusual, or even that he is ‘sick’ in any labelling sort of way

We are all sensitive to what others think, some more than others and some surprisingly so. Public speaking is a testament to this. Most people would prefer to bungee jump rather than risk being potentially ridiculed in public.

So it makes sense to me that the process of going out into the world from the hopefully secure family environment of a young man can be difficult. It means learning to deal with new people and to understand many different ways of communicating through speech, nuance, humour and body language.

I tried to normalise this process for this man. I wanted him to guess that anxiety is a normal part of this learning process. Anxiety is not a sign that he is different or unusual, or even that he is ‘sick’ in any labelling sort of way.

As the consult proceeded, I became aware of my nervousness in letting him go home with his dad and continue what he had started.

He had first acknowledged to himself that he has a challenge. Then, unlike many young men, he acknowledged this with someone — his parents, and they had developed the sort of bond where many things could be teased out. He was opening up to help from others.

The young man’s conversation with me explored some new areas to develop, alone or with his parents, and some new ways of looking at these challenges that were causing the anxiety. For the moment, I sensed a process had started and that a diagnosis, as such, was not necessary. Not yet. I gave a repeated sense to him and dad that there were many options and roads for us to take, but he himself was keen to work for a few weeks on the issues we had discussed.

In myself, I felt a tugging that we doctors are meant to be medicating or referring or labelling. That would cover me or absolve me. For me to trust that he is a competent young man growing into adulthood with normal scary feelings and anxieties was a little challenging. What if something went wrong and I missed it?

And all of this talking did not take that long in a busy surgery. Because you know what? We don’t have to ‘fix’ everyone, every time.

Sometimes we are part of a process of growth or healing, a pathway and a journey that the client-patient is taking. Like parents, we just have to nudge them in the right direction and then get out of the way.

  1. Karen M.Rogers on August 27, 2016 at 6:09 pm

    Thank you Dr. Heslin for writing this article that came up on my Facebook page today. In my own life, I know as a cancer survivor that most often people can heal themselves and their families if they take the time and dig deeper to find the issues to be resolved. Please keep up your insight and work towards skill-building in parent child relationships. Sincerely, Mrs. Karen Mischke Rogers in Edmonds, Washington, USA.

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