Friday, April 20, 2012

Family Medicine Activist: Using Creative Tension

Remember my post about Tension Mounts? Patient, Doctor and Prescription Tension Mounts
Tension isn't only negative.  It can be positive, even creative.  I enjoy creative tension.  As the poet Grace Curtis discussed the use of tension in her writing, Tension in Poetry, there is "tension—that creates a more pleasing and more important experience for the reader."  So, too, the Family Physician may employ the use of creative tension to help the patient to create a more meaningful experience in their interaction.  The relationship -based nature of Family Medicine develops a broad context in which the patient-physician engagement occurs.  This breadth, which includes extensive value sharing, enables the dyad of patient and physician to explore more variables that impact decisions during their current engagement (clinical encounter or office visit).  

Either party may seek a tension point to lock in an element of the decision(s) to be made as a result of this encounter. 
 "I can't really afford to smoke, I don't know why I continue." Patient
"Confusing, isn't it?" Doctor "Yes, I'm like trapped in smoke- and broke" Patient
"What would you rather do with the money?" Doctor
"I haven't thought about it that way." P
"Well, how much money is it?" D
"One pack a day at $5 a pack" P
"OK, so what would you do with $150 dollars each month?" D
"I would fix my car... and buy my mother a birthday present." P
"What about the trip with your son that you mentioned a few months ago?" D
"How did you remember that?"P  "I could remember how you looked and beamed when you talked about taking your son back to see your grandmother before she passes on." D
"That is important to me and will be a lasting memory for my son.  Can we work out a plan to quit smoking so I can do that for my son?" P

You may feel a bit of tension as the dyad of patient-physician above stays engaged around the issue of patient values, goals and dreams (aka, nicotine dependency and smoking cessation -for coders).  They discuss people, money, time, family, commitment, etc, in the clinical context of smoking cessation.  Both patient and doctor continue the creative tension as they move toward successful goal accomplishment.  The earlier value sharing in previous visits by the patient enabled the physician to mention the trip and the son which kept up the creative tension.

How might you use creative tension in your life?

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