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In healthcare knowing your patient is often what healthcare professionals strive for as a means of providing a comprehensive management plan suited for the patient. Knowledge is often an empowering experience but knowing your patient too well can be the cloud that blinds your judgment. I had an experience which changed my opinion of treating patients you know outside of a professional relationship. Initially, it was my belief that treating someone you know would be easy because there is already a relationship and rapport that exist to establish the therapist and patient relationship.

On the 22^nd of April 2019, I began my first day of the sports rehabilitation block at the University of the Western Cape clinic. I am a resident on campus and as I expected I was seeing a lot of familiar faces walking into the clinic, some of which I was acquainted with and others whom I had just seen in passing. One day someone whom I was well acquainted with walked into the clinic. This person was someone whom I did not get along with as we both felt indifferent about one another due to an incident that took place at the residence we live in. I was the only student physiotherapist available to see him and so my clinician asked if I could see him. I agreed and called him into the consultation room where the subjective interview took places. He revealed his medical history, which I had no previous knowledge of even though I knew him personally. He had bipolar, depression and he was HIV positive. I saw him around campus and could not look at him the same, we still pass each other and great each other awkwardly

As with all new experiences, there were various emotions that accompanied the varies events that occurred. Initially working with patients on campus made me feel comfortable in contrast to my other blocks which are usually feelings of great suspense and anxiety. The feeling of comfort transgressed into great discomfort when someone I was all too familiar with walked into the clinic and was to soon be my patient. I felt the environment become hostile as soon as he walked in considering the unpleasant nature of our relationship. When the clinician asked me to take him as my patient, I felt reluctant to do so but I did not refuse as I did not want to explain why. This task in hand stirred a great sense of professional responsibility as I was required to put my personal feelings aside and put the patient first. Initially, during the subjective interview, I was afraid to ask some questions as they felt too personal and we had never had to converse about anything very personal before that. At that moment I realized that my judgment was clouded. As the interview went on, I felt the atmosphere of hostility gradually float away, he allowed himself to be vulnerable, he confided in me and despite our differences, he trusted me. When I felt that he trusted me, whatever feelings of hostility that were present on my side evaporated. Although through this interaction we developed mutual respect as soon as I stepped outside of the clinic and no longer had a professional obligation, I felt burdened by the things he had told me. I felt anxious having conversations with his friends, afraid that I might let something accidentally slip and breaking patient confidentiality. I feel as if I now must remain a professional outside my professional environment.

This experience was not void of good and bad aspects. The good part about the experience was interacting with patients who I could relate better to as most of the patients were from the university. The good part about interacting with someone I had was familiar with and felt indifferent about was being able to develop mutual respect amongst one another. This mutual respect was found from interacting on a deeply intimate level. The bad part about this experience is that I interact with the individual and his friends on a regular basis. This is difficult because I feel burdened with his deepest secrete that I must withhold from everyone around him.

In hindsight, having had the opportunity to reflect and go through the literature concerning the provision of medical care to patients whom you have prior non-professional relationships with, I have been able to make sense of some of the events. I realized that the experience was initially uncomfortable because the patient and I were indifferent about each other. A qualitative study was conducted regarding medical students’ experience of working with prisoners, one of the themes identified in the study was that it was a learning experience (Brooker, Hu, Reath & Abbott, 2018). One of the lessons learned was the development of enhanced professional qualities (Brooker, Hu, Reath & Abbott, 2018). Although my patient was not a prisoner, I was able to relate it to my experience as it is highly likely that the medical students working with the prisoners did not have the same values or moral beliefs as the prisoners they were treating. The strategies the students used included consciously focusing on being non-judgemental and focus on being a competent health care provider (Brooker, Hu, Reath & Abbott, 2018). Regarding prior non-professional relationship, I learned that it complicates the professional patient-healthcare provider relationship in various ways. Regarding, my situation I was able to identify two concerns. The first concern was that due to the personal relationship it may have affected my ability to ask some information in the subjective evaluation and it also affected my ability to conduct some subjective and objective assessments as they may have made the patient feel embarrassed (Hojman, 2015). I also release that it is going to be difficult to maintain the patient confidentiality as if his friends were to approach me to ask about his health condition, they would be approaching me as a friend as opposed to a health care worker (Hojman, 2015).

In hindsight, having done some reflection and research regarding treating people you have a non-professional relationship with, what I could have done better is to explain to my clinician that I know the patient and I would prefer not to treat them for the above reasons. I realized that to do so would have been the more appropriate thing to do, as the assessment and treatment I gave him could have been inferior in comparison to someone in a more objective position and it has also put me in a position where I’m more likely to compromise patient confidentiality.

If a similar situation arises in the future having had this experience what I will do if it is a friend or family member is to refer them to someone with an objective perspective. As opposed to completely washing my hands off them I will support them through the process by offering education and advice to help them better understand the processes that they may be going through.

Reference

Brooker, R., Hu, W., Reath, J., & Abbott, P. (2018). Medical student experiences in prison health services and social cognitive career choice: a qualitative study. BMC Medical Education, 18(1). doi: 10.1186/s12909-017-1109-7

Hojman, H. (2015). A Friend’s Request for Treatment. The AMA Journal Of Ethic, 17(5), 428-431. doi: 10.1001/journalofethics.2015.17.5.ecas3-1505

Okes, D. (2018). Search Twitter – #DonOkes. Retrieved from https://twitter.com/hashtag/DonOkes?src=hash