Laurie Edwards, of ChronicBabe - an interesting support blog for young women with chronic disease - relates the similarities between finding her future husband and finding her ideal doctor.

Turns out, the world of dating and the world of doctors have a lot more in common than I’d considered. After all, who else has such access to the most intimate physical details of our lives?

She has some insightful and useful things to say:

So what makes the difference between a comically bad first date and a serious relationship, or between a physician who sees you as a chart and a list of symptoms and one who sees you as a whole person, distinct from a itemized list of meds or past surgeries?

Not surprisingly, it boils down to a question of compatibility and communication. . . .

A first appointment with a new doctor really is the medical equivalent of a first date. It’s all about the chemistry, that intangible sense that this person is worth another look.

Think about the ways we’re trained to evaluate first encounters of the romantic kind: Was he (or she) polite and engaging, or brash and curt? Was the other person merely hearing the words coming out of our mouths or actually listening to them? All of these litmus tests apply once you step into that exam room. . . .

I  knew early into our relationship—when [boyfriend] John shyly asked if he could learn how to do my chest physiotherapy—that I was onto something. Not only was he not scared away by my daunting array of conditions, he was actually asking to be a part of my reality. More than that, I was willing to let him.

At the same time, I knew there was something special about my newest lung doctor when he shoved my hefty pile of records to the side at our first appointment and said, “So, tell me about you. What do you do, what do like, and how I can help you get there?”

. . . Our relationship was sealed during our second appointment, when he told me we’d go over all my blood and lab work in a minute and then discuss treatment options, but first he wanted to hear what was new with me. How was my schoolwork going? Was I enjoying teaching? And did I have any new writing projects in the works?

He remembered, I thought. He really had been listening.

I went home from that second appointment with a sense of relief and excitement I hadn’t experienced in years. I’d refused to settle for a so-so relationship, and that paid off in the end.

Her parallels here are telling. She is demanding a personal commitment from her caregiver - that he care about her and take an interest in her. She had related “bad date” stories of men who were too arrogant or too self-absorbed, but she also noted doctors who exhibited exactly the same problems: being arrogant (putting her down to inflate their self-importance) and not being interested in her (insisting that their drug prescription failure was her fault). Her ideal doctor takes an interest in her interests and successes in life, aside from her lab tests or medical history. She likes him for the same reason that she likes her boyfriend: because he cares about and is interested in her.

Many people would agree that this is an ideal doctor; certainly it is an idealized treatment relationship, whether seen from a traditionalist or a contemporary patient-autonomy-driven perspective on the doctor-patient relationship. Those who mourn the passing of the family doctor, who knew every member of three generations of the family intimately, will welcome this kind of personal relationship between doctor and patient. Those who define the treatment relationship as the promotion of the patient’s goals and values will welcome the question “how I can help you get there?”, and the doctor’s interest in “the patient as person”.

From a practical perspective, I am often skeptical of this idealized view of the doctor-patient relationship, even when I rejoice for those patients who achieve it. I am not sure the context of modern medicine allows for this sort of thing on a regular basis, and I am not sure that is such a bad thing, if strong patient autonomy and a desire to assist patients in working through their needs and concerns, as a way of supporting autonomy, is an operative value. I would sacrifice a close personal relationship with my doctor if I could just find one who would do what I want, and I am not sure the former is necessary to the latter, however welcome it may be.

But that is not the point of Edwards’ post, nor of mine really. The point is that the relationship being entered into - and even if you conceive it within a fairly dry contract-for-service model - is fraught with intimacy and vulnerability. That is something that must be understood and respected by the clinician, however the treatment relationship eventually unfolds. Patients take a tremendous risk in exposing themselves to caregivers, and especially so for patients with chronic illnesses, who often have delicate manegement issues and extensively frayed nerves. Modeling the treatment encounter as a “date” emphasizes that vulnerability, and also the patient’s role as evaluator - as deciding whether or not there will be a “second date” - which is an important prerogative many patients waive. Edwards has offered a useful and intriguing way of seeing medical encounters between patients and new caregivers, one worth bearing in mind.

And . . . I just have to say: John, Good goin’, dude! “Can I do your chest physiotherapy?” I’m going to have to remember that one.