“Don’t do it,” our school had said, over and over again. “Don’t treat friends and family. Refer them out. Otherwise you’re just asking for trouble.”
I understood the basic message. It could be summed up as a Boundary Issue. As in, friends and family members tend not to have any. Or at least, they’re less likely to consider them (boundaries, I mean).
Family members remember when you were in diapers, mumbling in baby talk. Friends remember when you wouldn’t share the sky-blue crayon…or perhaps they remember you drunk-dialing your ex. Either way, the dual relationships can become…awkward.
Dual relationships are those in which two people share two types of bond. This happens a lot in the healthcare and caregiving fields. My cousin is my grandmother’s (adult) grandchild and also her certified senior caregiver. My mom and dad are my parents, but they’re also my patients. My spouse is my spouse, but was also my massage therapy client. And so on…
Even though I understood what my school instructors were getting at when they warned against this practice, I bristled against this unofficial commandment (“Thou shalt not treat family and friends”). After all, I had successfully navigated many dual relationships in the past, providing massage therapy to friends and family, with no unpleasant sequele.
I figured I could just carry over those principles to my chiropractic practice, too.
Well…yes and no.
I was blessed with delightful family and friends. It’s quality over quantity, and we’re very close. So what’s the problem?, I asked myself.
The problems weren’t obvious right away. They came on somewhat slowly. Or maybe they were always there, like a threatening storm gathering in the distance, and it was my realization of it that came slowly.
I’ll spare everyone the minute details of every encounter, but let’s just say I learned a few hard-ish lessons, and I can sum up the issues I found myself faced with.
They doubted/second-guessed me.
It was almost like they couldn’t let go of who they thought I was in decades past. They clung to their previous images of me. And as such, they couldn’t appreciate the learning process I had gone through, nor understand that I had indeed blossomed into a full-fledged, competent clinician. They couldn’t connect the dots between the stubborn kid who held intense, irrational “kid” beliefs and the rational, professional, metamorphosed adult sitting in front of them today, who knows about physiology, microbiology, nutrition, and so on.
I’m no stranger to self-esteem issues, so when I’ve worked hard to learn and achieve, being met with nonchalance and inactivity by those who are supposed to be my greatest cheerleaders is more than a little disheartening.
They’re not exactly compliant.
Maybe their thought process stems from the above. Or maybe they figure that because they’re your mom/dad/sister/brother/friend, you’ll always be there, whenever they need you. Therefore, in their minds, if they don’t follow your recommendations, because you’ll always be there to pick up the pieces. There’s a diminished sense of urgency, which naturally extends to following your directions. If you’ll always be there for them, there’s less of a reason to start doing what you tell them in a timely manner…
…which sort of ties into my next point…
The Time Boundary line is blurred.
In a typical clinician-patient relationship, you have office hours. Appointments are set, for a specific person, and for a specific length of time. Each appointment slot is designated for one person (or group), and there exists a common understanding that outside of that time period, you’re generally not available to those people, accidental grocery store encounters notwithstanding. An unspoken boundary is established.
When those people are friends and family, however, this time boundary gets blurred. Because you might call them during the evening or hang out with them on weekends and/or holidays.
This means that you’ll be available whenever they want to talk to you. And if there’s a pressing question weighing on their minds, they’ll bring it up during what would have otherwise been a personal “hi, how was your day” kind of conversation.
The truth is, I’ve gotten pretty good at separating my Office Life from my Home Life. And I might not know the answer to their question off the top of my head. Because I don’t have their file, with their exam and test results, their questionnaires, their supplement regimen, or other aspects of their care plan, within ready reach.
Brain-fogged friends and family can be even more frustrating.
It’s not them, nor is it you. They’re probably listening to what you’re saying, trying to take it all in, but they’re not going to comprehend concepts that you might perceive to be basic, and they’re not going to remember seemingly simple information.
So you might find that you have to repeat yourself. You might end up repeating yourself. You start to feel tired of repeating yourself. Like a broken broken record record.
The same brain-foggy phenomenon applies to other types of chronically ill friends and family.
And with them, the boundary lines blur even further. You receive a text over the weekend: your mom is experiencing a thyroid storm; your brother’s lumbar disc went out again; your friend is in the ER with another panic attack.
Like brain-fogged peeps, chronically ill peeps don’t remember what you said about the panic attack being rooted in their (lab tested) adrenal hormone excess. Your brother forgot about your advice to take it easy and limit his movements to your prescribed lumbar exercises.
Non-family/friend patients will make these mistakes, too, but when they do, they’ll call you in the morning–or on Monday morning–to tell you about it and schedule an appointment to remedy the problem. Friends and family generally don’t; they’ll call you at 8pm at night, or on Sunday afternoon, and they’ll want to know what they can do to alleviate the symptoms right away. And if you can offer some quick advice to hold them over until you’re back in the office again (advice you know–and tell them–is temporary), and they feel better again, they’ll mysteriously forget to call you during your office hours to schedule some time for a real treatment.
And especially beware the “proactive” “researcher” friends and family…
Chronically ill family and friends also often bombard me with links to books, podcasts, videos, blogs, etc. “Hey! Check out this link” or “hey, I found this book written by this pharmacist who has thyroid disease too!”, or maybe “have you heard of this magnet therapy (offered by this clinic that charges over three grand)? This one lady said it cured her Lyme Disease!”
And to make matters worse, they can start taking your expertise and spare time for granted.
I understand; I get it. I really do; I have (genetically-related) chronic health conditions myself. They’re miserable. Misery leads to desperation. Desperation fuels the seeking of knowledge. Knowledge is half the battle. But listening is another important component, and it’s really hard to keep giving advice for free, on what is supposed to be my downtime, to people who send me another link or frantic text from the ER (while at which point I can only watch helplessly) the very. Next. Day. Lather, rinse, repeat.
Yes, folks, even if you have the best of family members and friends, these things can–and do–happen. I do have the best of family and friends, and yet, all of the above have happened–and still happen–to me.
I know that it’s not their fault; after all, I agreed to take them on. I said I would help. I bargained for part of this, and I’ll own my part. However, there are certain elements of this that I did not agree to or bargain for. I agreed to take them on as patients, free of charge, in my office. They could set appointments and come see me without paying. I’m more than happy to do that.
I did not, however, say things like “hey, send me the links every ‘resource’ who claims to be an expert on every topic just because he or she mentions the key words” or “give me a play by play of every symptom you keep experiencing even though I’ve explained to you what it is and how to fix it (which they don’t follow)”, nor have I ever said “yeah! Attend a support group for your disorder and follow up on every fad-ish ‘remedy’ they mention” or “nah, these supplements and dietary recommendations don’t really need to be adhered to every day; you can cheat”.
There is a silver lining in the clouds, though. It comes when they text me on Saturday morning, after I’ve spent months explaining things over and over, and the basic message of the text is “a-ha! I get it now. Everything you said would come true, has come true. Everything you said would work, is working. Everything you said was a scam, is a scam. I keep coming back to you.”
And I guess that’s why I keep treating family and friends, even if it would make my school professors cringe. 🙂