Polyvagal Perspectives on the Doctor–Patient Relationship
Brain-Empowered Collaborators describes applications of Polyvagal Theory to understand physician–patient relationships. Awareness of the neurophysiology underlying reactions to illness and medical treatment informs physicians of when to build trust and when to gather medical information. By attuning to their polyvagal state and sending verbal and nonverbal signals of safety, physicians can activate the patient’s social engagement system, the optimum neurophysiology for decision making, comfort, and collaboration. A grounding in Polyvagal Theory enriches the tender and heroic partnership between patients and their physicians, offers insight into physician well-being, and suggests pathways to peace for the planet as well. Relationship becomes medicine.
Mark Roberts, a pediatric oncologist, knew that the boy could die before the day was over. Fourteen-year-old Tannor had been diagnosed with leukemia a year earlier. Now he was lying in a hospital bed with a fever and a tender belly, his mother a wary guardian at his side. The two doctors going off duty told Dr. Roberts that they were worried about appendicitis, potentially fatal when leukemia and chemotherapy have conspired to destroy the immune system. When those doctors had tried to examine him, Tannor had thrown them out of the room.
It was Dr. Roberts’s turn. Tannor’s mom was stationed in a chair to the right of his head, where she could see Dr. Roberts through a window well before he arrived. Tannor was motionless, his sheet pulled up to his shoulders, his legs extended stiffly down the bed. “When I entered,” Dr. Roberts told me later, “Tannor’s mother glared at me, but he kept staring straight forward, not even acknowledging my presence. Had he made the smallest gesture, she would have told me, ‘It’s time for you to go.’”