The other day a dear friend Rachel Hadas emailed to tell me that she “loves the intuitive wisdom, in cutting through Gordian Knots, that I demonstrate in my blogs.” I liked the sound of what she was saying but wanted to be sure that I understood the meaning of her words. So, as I often do, I looked up the definition of Gordian Knot. You see, Rachel is a renowned poet and professor of English Literature at Rutgers University and her metaphors are chosen with care.
I went online and learned that “The Gordian Knot is often used as a metaphor for an intractable problem (untying an impossibly tangled knot) solved easily by finding an approach to the problem that renders the perceived constraints of the problem moot (cutting the Gordian knot).”
I can’t say that the issues about the complexities of healthcare communication that I’ve described in my blogs “renders the problem moot” but it made me think about what it often takes to unravel the tangles in the knot.
First and foremost, doctor and patient must recognize their areas of expertise. We know that a doctor holds knowledge about the science of medicine and can offer advice based on what they have learned in training and through clinical experience. The patient, on the other hand, is an expert on the lived experience of illness and, if they understand their health status and risks and benefits of treatment options and quality of life considerations, they can actively engage in making informed decisions about care.
So, how does a doctor and patient untangle the communication knot? A good place to start is to recognize a shared humanity by placing oneself in another’s shoes. I recall Adrienne Barnes, who was diagnosed with pancreatic cancer, telling me about her disappointment and anger when doctors did not return phone calls or emails. I asked her what should be done about this. Her reply was “They should get sick.” Her point is well taken. If a doctor took a moment and thought about what it would be like if they or a loved one was seriously ill, perhaps they would have called her back.
It’s also true that doctors have a hard job with ever increasing demands on their time. Invariably, some patients may not receive the attention they need because of these time constraints and leave the office disappointed. I believe patients should tell doctors that you recognize the pressures they face and, if circumstances warrant, how hard it must be to engage in conversations when a treatment is no longer effective. It’s also important to let doctors know that you’re going to need their help and support in making decisions about care that align with “your preferences.”
Over the years, when I observed doctors and patients openly acknowledge to one another the challenges in navigating uncertainties about the course of an illness, they formed a partnership based on a shared humanity. Now, with the image of the Gordian Knot in mind, I can visualize it unraveling and opening up space for honest communication. By untying the knot together, doctor and patient can walk hand in hand into the unknown.
That was great. Beautifully written and on the mark. Great interpretation of Gideon’s knot
Ellen Perry Berkeley
We went out to Mayo Clinic quite a few times, starting when the doctor here (no longer here, thank goodness) said to Roy that he was thinking about himself too much — and didn’t even do the most basic investigation after Roy told of various symptoms that were bothering him. At Mayo, a month or so later, they found thyroid cancer. …………… The very good part of things at Mayo was that doctors were paid a salary — didn’t get money according to the number of patients they’d see. The doctors therefore could spend as much time as necessary with each patient. I don’t think we ever abused this system by taking too much of a doctor’s time, but it always felt good to be able to talk as much as was necessary. That was 30 and 40 years ago. They probably still have that way of doing things. We loved it.
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