Restraint is Built
Written By Dr. Geeta Sundar
They say that everything in moderation is ideal. Neither too much, neither too little.
Ah, but understanding what is just right, takes a long time to perfect and comes with experience. It’s like when you dine out, after a moderate amount of food as defined by you, for you, you know that your limit to saying done is near. But, restraint in medicine is a whole new ball game. It’s not the physical ones we strap around inebriated/hostile patients, instead they exist in all interactions of our daily life.
The statutory of these guidelines don’t come written in any book, and no matter how much you chase behind an ideal, it always leave you belittled or emotional. There are so many aspects in which a very tight restraint is advised to us as doctors. Whilst some are products of the society and its pressure, some are inculcated from seniors and legends, and others are an extension of our principles and beliefs.
But in each case, the degree of restraint to be exhibited is a learning as one grows.
We are taught to not be emotionally invested with patient’s to ensure smooth care giving and to maintain a doctor-patient professional boundary. Easier said than done, obviously! Because no matter what, at the root of all imaginable things, we are human and we feel, we hurt and we care. But self-control on not crossing that boundary helps in the long run as it compartmentalizes a personal from professional life.
There are restraints that we demonstrate with colleagues – friends, seniors, juniors – a kind of restraint with either saying as little as possible, or doing more than what is needed, or holding onto an emotion with grit. In each of these cases, we learn and re-learn and unlearn so many social cues, so many hard lessons of when not to speak, of when to remain silent even when you know the truth, of when to apply a filter to your ears as they hear all of the blasting noise, of when to swallow the hard pill of ignorance, of when to lend a support to a fellow in real need, or when to simply be the bigger person and forgive the one who can’t take the higher road.
And then comes the restraint we embrace with family. Sometimes what they don’t know is beneficial for them. Sometimes, we maintain the peace and mental health by holding back on information that might harm them. Therein, we deal with the intricate balance of the self’s super conscious and the family that lends us all the support we have. How much knowledge is adequate? To where do we draw the line? Is it worth it all, if at all?
As surgeons, more often than not, we are faced with the need to do more, to find a solution, and to over-do the surgery – to peel out all those adhesions, or dissect a bit more, acquire that margin clearance a little more, to divide and ligate deeply – to such an extent it causes more harm than good, furthers perioperative complications. In such cases, our hand talks and it’s the restraint we build in doing just the bare requirement than plays devil’s advocate.
Maybe its nature’s way and culmination of evolution that teaches us the means of restraint and the esteem in controlling our rough impulsive instincts to fine tune them into behavioral modulations to wear in society.