I am a physician, but I also consider myself a mother hen. When I have a census of patients, I think of them as little chicks, perhaps old roosters, clucking hens, tender capons. Some are old, some young, some have been chased out of the coop by an angry dog, caught in the wires and sent to me for care. Some may be bad eggs, but still deserving and in need of care. I have a maternal instinct, and I embrace it; I think it makes me a better physician.
As a physician in training, I was taught to avoid paternalism or at least to use it sparingly in special circumstances. Paternalism can be condescending. Assuming the patient does not know what is best, the paternalistic doctor makes recommendations without full explanation, discussion or negotiation. The paternalistic doctor states his or her opinion, then effectively ends communication. Through training, I have come to appreciate a distinct perspective, that of maternalism in medicine.
Maternalism can sometimes carry the weight of paternalism but with a softer side. Maternalistic physicians are not dictating to our patients what to do, but rather guiding them gently to what we think is best. We give our patients autonomy but never make them feel alone or unsupported in their care. We reassure them that no matter what they decide, we will be there for them. We care for the patient as a whole, not just an illness, but as a person with faults, weaknesses, with individual interests and goals, with human hopes and fears. We acknowledge our patients as the unique persons they are, and we love them all the same. Even if they don’t do what we, as maternalistic physicians, think is best for them.
Maternalism is what American medicine needs more of. It is what medical schools are trying to incorporate more of through humanities curricula, physician mentoring, medical ethics and public health. It is what many physicians, male and female, aspire to in patient care. Paternalism may be considered old-fashioned and largely inappropriate in patient care, but patient autonomy and shared decision-making models do not fully capture what it is that we as physicians should provide to our patients.
My mother once told me that you’re only as happy as your least happy child. As a maternalistic physician, I labor each day to help one patient at a time. Until all of my brood are safely tucked away in their coops or enjoying their free-range farm, I won’t be content. When a patient has a difficult day, I think a little harder, read a little more, or peck away at various ideas to make them a little better. Some days, I’m only as happy as my least happy chick.
When my patients have improved, completed their therapy or clinically stabilized, I feel that they’re ready to leave the nest and fly, waddle or limp back home. Maybe they’ll call on me if they need me again, but maybe they won’t. If you don’t hear from the spring chickens often, they’re usually doing just fine. As a maternalistic physician, an unapologetic mother hen, I am happy to know they’ve gone home to roost.
Elizabeth Horn is a resident physician.
Image credit: Shutterstock.com
