"What does 'BALINT' stand for?" asked Dustin, a bright-eyed third year family medicine resident. His earnestness shined straight through his white coat. His friend Matt looked just as purely interested, leaning onto the pressed wood cafeteria table in teal scrubs, listening for an answer.
I hung out with the residents and medical students from 8-9 AM at Greenbrier Valley Medical Center in Lewisburg, West Virginia yesterday. I was asked to speak 'off the cuff' with these trainees.
"I don't know what to talk about," I had confessed to my wife Judith, just two nights previous. We sat in our PJs, eyelids heavy.
"Why don't you run a Balint group?" she asked casually.
Judith is a genius.
I sat erect in my chair in the doctors dining room, sealed off from the rest of the cafeteria. I was kindly introduced to the group by my med school mentor, Bob Foster.
"Hi everyone, I'm Frances Southwick, and I'm an Osteopathic family doctor in Pittsburgh," I began. I looked into the eyes of each med student and resident around the large table. The room was a bit awkward and tense. I felt such warmth for them. I could feel their good will and eagerness pouring out, ready to talk.
"Balint is not an acronym, but it sounds like one!" I laughed. "It's actually a last name - Drs. Balint and Balint invented a way to reduce physician burnout in the 1960s," I explained. We would discuss an actual case they had been struggling with, and explore the doctor-patient relationship. I asked if anyone had a difficult patient case they would like to talk about. One resident's hand shot up in just three seconds, and we dove straight in.
The group of us talked our way through each character in the difficult medical predicament. (HIPAA, medical ethics and Balint confidentiality prevent more detail here). The patient. His partner. The nursing staff. The med student. The resident. The attending.
What would it like to be each of these players, day in and day out?
How frustrating...when no one knows the best thing to do, but all are pretending to know?
What should we do about the unexplainable abnormal physical examination findings?
What is acceptable to ask the patient, to demonstrate respect for him and simultaneously get accurate medical history?
How do we communicate with one another?
What do we do when we don't know what to do?
By the end of the Balint session, we were unified. We understood one another's roles even more clearly, now that we had meticulously empathized.
I thanked all for participating. The tension in the room had dissipated.
Maybe it's enough to admit we don't always know...
...But we care.