Good Fences Make Good Patients

“This is what a teacher once said to me:

You’ve seen farms with wooden fences around them, right? They have posts every few feet. Logs link the posts together. Farmers or ranchers rest their feet on the lower beams and lean on the upper beams. They look out over these fences at their crops, their livestock. You see that?

Imagine you’re out there and you see your patient leaning against the fence. If you’re respectful, he’ll invite you to stand next to him. Now you can both lean against that fence and share the view, see what’s on the other side. Farm land, mountains, valleys, whatever.

That’s exactly where you want to be. You want to stand next to your patient and listen to what he’s telling you. He’ll tell you what he sees and what he thinks about all of it. You’ll have the same perspective. You can talk about that thing out there and you’ll both be on the same side of the fence.

That’s how you can start understanding who he is and where he’s coming from.”

I like this metaphor, and I would extend it further.

In good longitudinal patient care, you and your patient start at one corner of the fence. The goal is to walk down the fence, all the way to the other end of the lot, without either of you running away or needing to build the fence up (or, tear it down!). As you walk down the fence, over the course of visits, months, years, you each pass things from one side of the fence to the other: compassion, advice, treatment, medication. But the fence endures, and it shapes your relationship, even during a lifetime of walking. You don’t cross over, you watch and walk side by side, separated. Because you each have many fences to walk, and crossing one would invite crossing all. Some fences are higher, and some fences are lower, but their rails guide you along your journey, together.




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