A common error is made when training a horse. It goes like this:
A rider’s horse is in the field, hundreds of feet away. The rider calls to the horse—nothing. The rider whistles—still nothing. Eventually the rider marches through the grass, up to the disobedient horse, and yanks on its halter angrily: “You should’ve came when I called!”
The next time the rider comes to the field and calls for the horse, the horse stays as far away as possible. It won’t want anything to do with that person, because all it remembers is being marched up to and yelled at.
Essentially, the rider felt insecure without control. Things were not occurring the way he wanted them to go in his head, so in a fit of frustration the rider sabotages his purpose. It takes a long time to undo the damage of this initial error.
Doesn’t this sound familiar? We make spur-of-the-moment decisions after our insecurities have led us to anger, frustration, or jealousy. We sabotage the things we say we want because we’re blinded by needing control. We take things personally: Instead of looking at people (or horses) as flawed beings who will do what they want to do, we think they do things to us or in spite of us. In reacting to those very moments, we sabotage ourselves.
The experienced trainer handles the situation differently. The experienced trainer calls the horse, and again, the horse doesn’t come. So she marches through the grass to the horse, but instead of handing out punishment, she hands out praise. She gives the horse treats and scratches its ears.
The next time the trainer appears in the field, the horse is more engaged and willing to interact with this person. Ultimately, it is much more willing to be trained.
By relinquishing that initial desire to establish control and dominance, the trainer gets what she wants. She didn’t have to “get back” at the horse. She took nothing personally, she understood the process and approached it with love.
Now. How does this apply to medicine?
In medicine, we want control. We want to tell someone what they should do, and we want them to go home and do it. There is common complaint from medical professionals that they’re not able to help their patients because their patients don’t want to change. The cheetos-and-alcohol filled diets, the sedentary lifestyle, and the unaddressed stress are assumed to be constant variables of which physicians have no discernible influence.
This leads to frustration and anger: why would you help someone who doesn’t want to be helped? And my answer to that would be: you wouldn’t. But, patients do want to be helped, we just interact the wrong way.
Nobody is receptive to being controlled. Patients feel patronized. Clinicians feel powerless. It is always a lose-lose situation when one person tries to control another. (This applies to the physician-patient relationship, to significant others, to children, to anybody.) Control is never the answer.
The answer is two-fold: First, compassion. Second, detachment. Let me explain.
First, compassion. This consists of genuine concern for someone and a desire to help them. This is not sympathy, which says “I feel bad for you;” and it is not empathy, which says “I feel what you feel.” Compassion says “I recognize what you’re going through and I want to help you.” It is an authentic caring for another human without going there yourself (because if you are suffering, you cannot give them your best).
A compassionate relationship is based in patience, in understanding, and in love for another human. If a patient does not do what the clinician recommends, the clinician has the same options the trainer approaching the horse in the pasture has. Either get upset and retaliate for the undesired behavior, or approach the situation lovingly and curiously. The former option is easier, but the latter option has profoundly more impactful results.
The second aspect of a healthy relationship (again, this may be physician-patient, significant others, parents, or friends) is more counterintuitive: detachment. This means we should not be personally invested in the actions of another human. I can be excited for someone, or sorry for him, or happy, or angry—but I should always keep in mind that he is autonomous and has chosen his behavior in a way that has nothing to do with me personally. The personal detachment prevents defensive reactions.
For example, if a patient does not do what a clinician recommends, it can manifest in several ways. A personally attached clinician might become frustrated, saying, “why didn’t you do what I told you to do?” And unattached clinician would ask, “why doesn’t this seem to be working for you?” It is a minor change but has very different results in dealing with another person. Patients want someone who will work with them rather than order them around. And if we want patients to do what we recommend, we must—counterintuitively—relinquish our desire for control.
The next time something isn’t going the way you imagined it to go, be reminded of which type of horse trainer you want to be. Will you become angry and desperate for control? Or will you become curious and approach the situation with love?
I hope we are all able to choose the latter option in this new year.
