Tuesday, October 11, 2005

Rules of Engagement

Wars are fought according to prescribed rules of engagement. Facilitated discussions are conducted according to a set of rules that everyone agrees to up front. But most relationships, most e-mail communication, just happen with no predefined rules. There is no discussion of what topics are appropriate or what level of closing is used (ranging from “regards” to “take care” to “love”).

I have struggled with this issue for a year in my relationship with Rebecca, my massage therapist who is also some sort of a friend. I have even asked her to clarify what topics are acceptable for e-mail discussion, given our relationship as massage therapist-client. Our boundaries have been drawn and changed and re-drawn multiple times. There have been some bumps in the road, but I think our relationship is on stronger ground than it ever has been.

Just as one relationship comes under control, another one has become a problem. Never before Deborah had I had a doctor who was also my friend and musical partner. We had never had a discussion of when it was appropriate for my health issues to be a part of our conversation or our e-mail exchanges.

In desperation I recently e-mailed Deborah after my appointment with my surgeon, wherein I became alarmed about the potential of chronic thyroid cancer. She has now made it clear that I shouldn’t be using her personal e-mail address for this purpose.

I contacted her because I found that I had no one who could answer my questions about the next 3 months and the rest of my life since my brand new endocrinologist left WHC just two weeks after I saw her for the first time. Deborah responded with the name of another endocrinologist at WHC.

I felt extremely badly about continuing to involve Deborah and requiring her time in my thyroid woes, when she is not being compensated. I told her that I was more than willing to pay anyone who was willing to talk to me. I was happy to make an appointment, make a phone call, or deal with my questions by e-mail, gladly compensating the person on the other end for his/her time. She mentioned that she could not charge for anything other than a personal appointment. I have trouble understanding this, given my previous internist, Dr. Lamb, who even though he had his faults, did have an e-mail policy with a charging algorithm. Daniel’s psychologist has had telephone appointments with him for years.

Making appointments with really good doctors in this area is a problem. I proved this just one more time when I attempted to make an appointment with the new endocrinologist, Dr. O. I left two phone messages which were never returned. Deborah gave me a new number to try. This time a receptionist actually answered the phone, but she said the first available appointment was February 16, just three months after my surgery. Deborah intervened and today I got a phone call from the doctor himself, who offered me an appointment next week.

Deborah and I still haven’t had a discussion about what topics are appropriate outside of her office. But if I had to make a choice between keeping Deborah as my doctor or keeping her as my friend and musical partner, I’m not sure what I would do. I really value her in both of these roles. Maybe it would be a good idea for Deborah and me to develop our own rules of engagement, just so there is no doubt in the future.

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