The fast paced, energetic,aspects of medicine in this country can be characterized as being “hypomanic.” Although referring loosely to the familiar Diagnostic and Statistical Manual of Mental Disorders (4^th ed.; DSM-IV; American Psychiatric Association, 1994) criteria of hypomania, my description is more akin to the ideas of Melanie Klein and what she called “manic” defenses.

Klein described manic defenses as when idealization, feelings of being powerful, and hyperactivity are employed to ward off sadness, worries about aggression, and ambivalence, all of which are familiar feelings when dealing with doctors and illness.

Even minimal experience in the medical profession leads one to appreciate the consequences of a hypomanic culture. Particularly in hospitals, people talk fast, move fast and think fast. Even in outpatient settings, patients remark that they spend only 5–15 minutes with their physician and commonly complain that doctors are rushed and pressed for time.

This kind of pressure and a speed-driven culture has a rational component; when a patient is critically ill, physicians and medical staff need to move quickly in order to administer urgent care, which could be life-saving.

Medicine has changed dramatically because modern physicians can offer a higher quality of treatment and care to patients than in the past. One hundred years ago, physicians had little to offer patients in the way of a cure, so instead they provided comforting words and a personal rapport. As medicine has advanced, the kinds of interpersonal connections within medicine have changed. Winnicott (1966) described the way he experienced changes as a result of a more modern medical practice:

“It is a sad result of the advances in modern medicine that there is no personal clash between patient and doctor as whole persons; there is a visit to the doctor, a disease process found, treatment is given, and the disease is cured, but no one has met anyone, no one person has bumped into another person (p.183).”

Many people experience lack of interpersonal connection in the present-day medical encounter. Medicine demands a great deal from its practitioners and a hypomanic style in the personalities of medical professionals can be viewed as a kind of acculturation to seemingly endless demands. On the other hand, the perpetually fast pace in medical facilities also reflects a tendency and desire to not engage with patients in an emotional way.

Doing something (i.e., acting in a concrete way to solve a problem) is the dominant response to medical issues in this country.

How does one achieve reflective thinking when interfacing with medical professionals? It seems that the odds are against patients.

First, you have to divorce yourself from the idea that just because physicians are moving fast that you need to as well. You do not.  Patients have the luxury of requesting their physicians to slow down. Although many doctors might feel pressured, they often are receptive to reminders that an in-depth conversation is better than a superficial one. After all, it saves them time in the long run.

Second, be aware of your own anxiety. As patients, when we feel overly nervous, we tend to accept whatever our physician has to say. No one thinks clearly when anxious. Tell yourself it is okay to slow down.

Finally, remember that medicine is not like how it was when many of us were children.  This is disappointing. But managing disappointment helps us to be assertive when dealing with doctors.

Medicine is a fast-paced world, and there is a lot to be nervous about when talking with physicians. Tell yourself and your doctor it is okay to slow down, even if it is just for a minute.

Portions of this blog were taken from the book, Psychodynamic Perspectives on Aging and Illness.

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    Last reviewed: 29 May 2011