Monday, February 14, 2011
The therapeutic relationship in "The King's Speech"
Recently I saw "The King's Speech." The film is about King George VI, Duke of York, and his struggle with a speech impediment--a stammer. The story tells of how King George IV, "Bertie," worked with an actor turned speech therapist, "Lionel," to overcome a chronic ailment, which was the source of significant psychosocial stress. I found myself reflecting on what aspects of the therapeutic relationship displayed within the film were so successful. Despite his lack of official credentials, I felt that Lionel Logue displayed tremendous professionalism as a care provider.
One aspect, I believe, was the genuine friendship that developed between the two men. Whether it is advisable for doctors and patients to be friends has been a matter of debate. Within the field of psychiatry this has been seen as a boundary violation that is fraught with problems. However, within other fields of medicine boundaries may not be as rigidly enforced. In my view friendship, at times, can enhance a therapeutic relationship.
Another successful aspect of this therapeutic relationship was Lionel's exploration of not only the biologic, but the psychosocial contributors to King George's speech disorder, which had roots in his childhood family dynamics. I am a believer in the biopsychosocial model of medicine. In order to understand and treat illness, one needs to understand not only the biological factors, but the psychological and the social context in which the illness occurs. This is also known as "holistic medicine," though this terminology is widely misused today by those who confuse it with "naturopathy" or "homeopathy."
A third aspect that enhanced the patient-caregiver relationship was that it was non-hierarchical, neither Lionel was "Doctor," nor Bertie was "King." It was important to Lionel that each man should be equal in the context of treatment, and he insisted that each call the other by his first name.
Finally, Lionel was very discreet, serving as trusted guardian of his patient's confidential health information. He protected his patient's privacy and autonomy.
Medical Professionalism is one of the core competencies of the American College of Graduate Medical Education used in the evaluation of medical trainees. A growing movement has attempted to define the best way to measure and teach professionalism. The core attributes of Medical Professionalism were defined by a Charter drafted in 2002. A recent paper in JAMA discusses specific behaviors and systems that support medical professionalism.
Some key elements described in The Charter are:
--Protecting patient confidentiality
--Maintaining appropriate relationships with patients
--Commitment to scientific knowledge
--Improving quality of care
--Improving access to care
--Allocating a just distribution of resources
--Maintaining trust by managing conflicts of interest
--Participating collaboratively within the profession to maintain professional standards
I see professionalism not as a static set of values and behaviors, but as flexible standards that are shaped throughout the course of one's career both through observation and through trial and error.
In "The King's Speech" Lionel admits to Bertie that he has pushed too hard, was insensitive, and took a wrong tact. He comes to apologize to his difficult patient. The willingness to admit fallibility and error is another important aspect of medical professionalism.
This film could be a great tool for teaching medical trainees.
Juliet K. Mavromatis, FACP, is a primary care physician in Atlanta, Ga. Previous to her primary care practice, she served on the general internal medicine faculty of Emory University, where she practiced clinical medicine and taught internal medicine residents for 12 years, and led initiatives to improve the quality of care for patients with diabetes. This work fostered an interest in innovative models of primary care delivery. Her blog, DrDialogue, acts as a conversation about health topics for patients and health professionals. This post originally appeared there.
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