The Mask

Dr Dork is not a psychiatrist.

However, one skill he recalls well from his time as a psychiatry registrar is that of the mask. The façade.

This is a necessary thing, at times, in all of medicine. Particularly psychiatry.

A fundamental ethos of medical practice is the necessity to maintain an emotional distance from ones patients. The principal reason is to enable objective judgements to be made, without emotional bias. This protects patients.

Doctors in Oz are discouraged from treating family or close friends, for example. Our emotional attachments result in us usually either undertreating or overtreating. Both of which can be harmful.

Primum non nocere, after all.

A doctor allowing their emotional reaction to a patient to compromise their decision making is perhaps an example of countertransference. A good doctor provides the optimal care to each and every patient, be they saint or sociopath.

But doctors are subject to emotional reactions just like everyone else. Some of us get very desensitised, unfortunately, as a protective defence.

The key, at least to Dr Dorks mind, is not allowing our emotional reactions to affect our decision making. And, obviously, to not express our emotional reactions. Whatever they may be.

To maintain the facade. Protecting the doctor, perhaps, but principally protecting the patient.

Yet we still feel. We feel the lonely, lingering, untimely death that we cannot prevent. We flinch internally at the barrage of expletives. We seethe inside at the dozen old fracture lines on the malnourished childs Xray. Our pulse skips a beat at your drunken threat to our family.

We all learn to wear a mask.

Sometimes it’s hard to take it off.