From Detached Concern to Love: Reframing Patient-Physician Boundaries with the Help of Saint Augustine
Anjola Onadipe, Duke Divinity School, Theology, Medicine and Culture Fellow, Durham, NC and University of Michigan Medical School, Ann Arbor, MI
Developing appropriate professional boundaries is part of becoming a mature clinician. Boundaries help physicians fulfill their duties in relationally complex and emotionally fraught situations. The concept of “detached concern” has been used to characterize patient-physician relationships in which physicians show concern while maintaining emotional distance. However, many trainees feel that significant detachment occurs by default. Consequently, professional boundaries based on detached concern may be counterproductive by diminishing connection with patients, leading to clinician disenchantment and patient dissatisfaction.
Instead of detached concern, a better framework for the patient-physician relationship is love, at least the kind of ordered love described by Saint Augustine, the 4th and 5th century North-African bishop. Augustine’s conception of love is a type of attention towards others that wills towards their good. Furthermore, Augustinian love is aware of the limitations of human love and it comes with safeguards for which there are corollaries with professional boundaries in the clinical context. These safeguards include guarding against forms of compassion that interfere with reasonable judgement, acknowledging humans' finite capacity to love, and recognizing potential harms of disordered love. Against a horizon of love, however, such boundaries are transformed from walls that primarily prevent human connection to walls that encourage human connection that is in line with the patient’s healing and their good. By shifting our emphasis from detached concern to love, medical practitioners and trainees can re-enchant medicine through the human connections that make the practice of medicine its own reward. Within this framework, clinicians are empowered to love God and love our neighbors through our vocation in medicine.
Instead of detached concern, a better framework for the patient-physician relationship is love, at least the kind of ordered love described by Saint Augustine, the 4th and 5th century North-African bishop. Augustine’s conception of love is a type of attention towards others that wills towards their good. Furthermore, Augustinian love is aware of the limitations of human love and it comes with safeguards for which there are corollaries with professional boundaries in the clinical context. These safeguards include guarding against forms of compassion that interfere with reasonable judgement, acknowledging humans' finite capacity to love, and recognizing potential harms of disordered love. Against a horizon of love, however, such boundaries are transformed from walls that primarily prevent human connection to walls that encourage human connection that is in line with the patient’s healing and their good. By shifting our emphasis from detached concern to love, medical practitioners and trainees can re-enchant medicine through the human connections that make the practice of medicine its own reward. Within this framework, clinicians are empowered to love God and love our neighbors through our vocation in medicine.