When To Say When On The ‘Savior Complex’

I am here to tell you that last week I got my mind whipped and I loved it. I know what you are thinking and don’t even go there. Yes, sir, whipped glia with a little dash of neuron. A puree of all purees. It was a full-on mental Mixed Martial Arts fight I had and I got whipped by the “Three Foot Giant.” Once in a while, a good old ego-beatin’, astrocyte kicking is what you need. Now the next question is: how did this poor soul find himself in this type of situation for such a heinous event to occur?

Through networking with some colleagues, I was invited to this physician networking dinner meeting with this invited speaker my buddy told me I had to hear. Little did I know that he would end up being my eventual opponent in the cranial dueling cage. There was chit-chat here, some healthy food, unfortunately no wine (I was about to leave right then and there, but my colleague restrained me), and a bunch of folks I did not know. So after getting comfortable with some of the docs, it was time for the invited speaker to come out and give us an hour-long talk about who knows what. However, it was supposed to help us. That is what I heard.

That is when Sean Stephenson rolled out onto the stage (really the front of the room because there was no stage here but by the end, he made it a damn stage) in a small wheelchair. Now if you don’t know who this giant is, I suggest that at the end of reading this DPM Blog, you Google him. He is only three feet tall and, as he told it, suffers from osteogenesis imperfecta and was not expected to live more than 24 hours after being born. However, all our perceptions about the limitations of this man's disease dissipate within seconds when he starts to speak.

It turns out that this man is a mental giant and has incredible insight into being a human and a doctor. I guess most of the time doctors and humans are one and the same, but I can truly think of a few who have a very small crescent on the Venn diagram. So how did he whip my mind?

Well, he told us a lot of what we already knew but he was able to package it in a manner that had a magnificent holding power. It was akin to a beautifully skilled master musician playing a song that we have heard hundreds of times before but he was playing it with such heart and elegant delivery, it was like a new piece.

“Rapport,” he said, is what makes all the difference in a physician-patient relationship. You have to build that with every patient to reach ultimate patient outcomes. By the way, you greatly decrease medicolegal risk at the same time. How do you build rapport, you may ask? Well, according to Sean, you must first gain the trust of patients and then you really have to respect them. These are not necessarily easy tasks to accomplish and quite frankly, it may not be possible with some patients, no matter how hard you try. If that is the case, you might want to rethink about retaining that human as a patient.

However, it really started hitting me when he started talking about the “Savior Complex.” The Savior Complex, for those who don’t know what that is (and nearly every doctor I have ever known has including myself), is where you believe that you can help everybody. No, you can’t. However, “No, you can’t” is not in our corpuscles and the marrow of our bones. We are healers, dammit, and we are going to heal everyone whether they like it or not.

Now if you think about this a minute, it really hits you (remember at this time I’m not drinking a beautiful deep inky cabernet so I am not truly impaired when it comes to deep thought). You can’t heal everyone. Now ask yourself what makes the clinic so difficult, both physically and mentally? It is either employees or the patients. Sometimes it is IT when the connectivity goes down and your EMR locks up, but most of the time, it is that patient. You know the one. Chances are you see his or her name on the list of scheduled patients that day, the hair on the back of your neck stands at full piloerection, and beads of cold sweat start to run down your face.

I would proffer that if you could eliminate those very few patients from your practice right now, your quality of life would escalate to new unknown heights, coronary stress would diminish and practice would become more fun. We are talking about a handful of patients because most of the patients we have are absolutely great folks. However, those few bad tangerines can ruin the citrus cart.

So, Sean, in his stellar opus, told us about how the Coast Guard decides which people they save in a shipwreck if they can’t save them all. I had never really thought about this but certainly they have algorithms as do all cogent organizations. How do they decide who to save if they cannot save them all? Very simple. They save the ones who are swimming toward them. That is right. They save the ones who want to be saved.

Now when it comes to patients, can we really save those who are swimming away from us? Sometimes it is hard to determine which direction they really are swimming. Oh, if you ask them, they are always Michael Phelps swimming right at you but we know that is not the case.

When A Referred Patient Has Had An Ulcer For More Than Three Years

For example, one of my colleagues asked me to consult on a patient with an ulcer on the plantar aspect of his first metatarsal head. The ulcer had not healed after more than three years of treatment. Doctors had thrown everything at this bad boy. You name it: bone resection, debridement, offloading (supposedly), gastrocnemius recession, voodoo. Literally everything. I went into the consultation room.

There it is: a nice, well-described 2 cm hole on the bottom of his foot at the level of the first metatarsophalangeal joint. It was not infected to a significant degree and did not probe to bone. The day-old radiographs showed no lytic changes. This guy was a nice man and a very hard worker, a salt of the earth type of guy. I reviewed his chart and saw that he was a smoker for about 30 years, and could not do offloading because he had to work. So he was npt swimming toward us here, was he? No, he was just treading water. He also was not wearing his offloading boot. So I asked him a couple of questions.

1. Would he quit smoking? “Probably not.”

2. Would he become non-weightbearing? “I have to work.”

I exchanged some more pleasantries with him and told him I would send a report to the referring colleague within the next week.

I called my colleague and said that the best thing to do was to send him to another provider as this patient was not swimming in our direction. I felt bad about not helping this nice man but what were my chances of healing him? Less than if the wound got infected, he got osteomyelitis and then decided his problem was my problem.

This was my first step in recovery from the Savior Complex. It was difficult and felt completely foreign, but I somehow experienced a light of freedom.

What's the bottom line? Don’t swim after them.