Doctors, patients, and stalkers

After learning that Mrs. Tishell returns to Portwenn and will probably continue her fixation on Martin, I realized I should say something about doctors and the real experiences they have with patients/nurses/and the general populace becoming infatuated with them. We also can’t overlook the very real affairs doctors sometimes have with their patients. In addition, in a small town patients and doctors often interact on a social basis even if there’s no intimacy involved, but it can be awkward.

I know about this sort of thing because in the small town in North Carolina where my husband practiced medicine for many years we had numerous encounters of this kind. Sometimes I wondered if we were living in a mini Peyton Place! I guess you could say that doctors are in a position of authority and may often save patients from dire circumstances. Many times patients confuse concern for their health and welfare with other deeper feelings for them. Then there are the patients, like Mrs. Tishell, who have psychological problems and develop delusions that their doctor loves them. In Doc Martin it’s funny that this grumpy and rude doctor becomes the object of the chemist’s affection because most of the town thinks he’s obnoxious and calls him “tosser” and any number of other names. She, on the other hand, tries to impress him with her medical knowledge and does as much as she can to get his attention. He never gives her any reason to think he’s interested in her, but that doesn’t stop her from believing they have a close connection. She’s not really a stalker, but when she cracks and abducts the baby, she reveals how delusional she’s become. In Portwenn, like in the small town we lived in, women could be calling the doc at all hours of the day and night, or leaving him messages on his cell phone, or sending him presents (much like 15 yo Melanie does in season 1, episode 5). Then it’s up to the doctor to figure out how to get them to stop and it’s not always so easy. We shouldn’t forget Mrs. Wilson who also wants to get Martin’s attention and flirts with him. She even gets him to make a house call for a totally trumped up reason. In her case, his status appears to attract her, although she may just be intrigued with making a new conquest. Martin is not susceptible to her advances and his naivete keeps him from realizing what she’s up to. His naivete is probably the reason he never notices Mrs. Tishell’s efforts as well.

I found it very amusing and startling when Martin accuses Louisa of possibly having de Clerambault’s syndrome or Erotomania after their intimate conversation in season 2, episode 8 when he declares his love for her while under the influence of wine the previous night. Here he is staring at her through windows and following her liaison with Danny, and then being obviously relieved when she tells him that she and Danny have split, but he can’t handle it when she comes by the next evening to tell him she loves him too! (Once again the writers, or consultants are pretty amazing with their knowledge of medical terminology.) In their case we have a mutual attraction to each other that must jump many hurdles before and after they finally end up together. Louisa, nevertheless, has to decide how to manage going to Martin as a patient after they establish a personal relationship. Several times she considers changing to a doctor in Wadebridge because of how awkward it is to talk to Martin about her personal health problems. She signs up for prenatal care in Truro, although there are occasions when she ends up having Martin treat her during her pregnancy. Naturally it is odd and difficult to have Martin as her physician when she is unsure of their relationship and trying not to force him into a situation that she’s not sure he wants. Moreover, if they were married, he wouldn’t be her physician. Doctors (by law in America) don’t treat their own families, unless there’s an emergency and no other physician is available.

I can state unequivocally that socializing with one’s gynecologist or gastroenterologist is quite uncomfortable. He’s either done a gynecological exam or a colonoscopy on you and now you’re having a drink and making small talk. The doctors are professionals and do their best to just be friendly, but it’s kind of hard to forget that they’ve been up close and personal with you. I was often friendly with their wives too. How weird is that?

Alternatively, in our small town, there were several physicians who had affairs with patients. Of course, that is considered unethical and, in at least one case, the physician lost his license to practice medicine. But where do you draw the line? What if you are a doctor and you fall in love with someone who lives in your town and who happens to be a patient? In the case of Martin and Louisa, there is some grey area. Both of them are unmarried, they are consenting adults, and there is only one doctor in Portwenn.

But in most cases, Mrs. Tishell is a much better example of what happens. The delusional patient is set right by the doctor and hopefully receives treatment and overcomes her infatuation. Being a doctor certainly involves more than patient care!

Originally posted 2013-10-04 02:58:38.

9 thoughts on “Doctors, patients, and stalkers

  1. Linda

    I missed this post but found it most interesting. I think the issues with Mrs. Tishell would make for an interesting discussion. While she is very amusing, it is really sad too. She is a real “fruitcake” ,to quote Louisa ,but she is also lonely and misundersood. She really IS a faithful practioner in the community and every single person who lives there avails him or herself of her services. She is always very loyal and helpful to Doctor Ellingham and in truth, he really needs her services.

    I live in a fairly small place too and we socialize with and attend church with several doctors and their families. Indeed, it is a bit weird to have a social relationship with someone who has seen your private parts but doctors are PROFESSIONAL and DISCREET. It has never been the slightest problem. No doubt, patients are far more irksome to the docs than the other way around! One funny (or not so funny) experience I did have, was to have my doctor call me and say he was coming by my house to talk to me. I was nauseated with fear. He handed me an envelope and said he would talk to me in a day or so. Then he left. It turned out to be a recruitment attempt for Amway. I was furious and made an appointment to see him. I told him I was NEVER able to call him at HIS home nor arrive on HIS doorstep and that I was not only offended but really angry. I threatened to complain to the CMA about him but stopped at telling him I would no longer have him as my doctor. I later heard he had pulled this on several patients and staff at the hospital. It was too bad because, I really respected him as a doctor up until then and as a family, he had been really good to us.

    Louisa’s initial problem with Martin being her doctor, came about as a result of her fainting at the harbour while reading to her students. I loved the way they dove-tailed her story with videos of Martin, representing him as the prince and she the princess. If you recall, he wanted to take her up to the surgery right off and thought that it was more important than “finger painting or whatever the next lesson” was. I suppose he thought those primary kids could just go back to school on their own through the windy streets and traffic. Apparently, he had not considered her professional duties as a teacher to be very important. It was funny for a man who is such a stickler for professionalism and best practice in his job! Anyway, he compassionately examined Louisa that evening and asked her good and usual questions relating to her fainting. These made her uncomfortable especially when he asked her if she could be pregnant and suggested she could be entering menopause! He, of course, did not get why she was squirming and she couldn’t say that she was uncomfortable because they were beginnning a relationship. She used this moment to bang on about her having to initiate everything as a way to explain why she would go to Wadebridge. It was an interesting aside. He didn’t get it of course! Later, she came to ask him if she could stay. Interestingly, he said ,”of course”, without knowing she was talking about staying at the surgery. She didn’t get THAT. It led to a very nice exchange between them – one of my favorite episodes because of it. Both were soft spoken, making eye contact, and really talking for once. It was great.

    When she returns pregnant, I think you are right to say she registered with Truro so that he would not be put into an uncomfortable position. Sadly, she was VERY wrong about this. She made some wrong assumptions and made some poor choices. She also ticked him off frequently. He really wanted to be a part of the pregnancy and even suggested he should be taking her and attending her appointments at the hospital. SHE blew HIM off. Sadly, the pregnancy was marred by several ugly and disrespectful exchanges. Once again, they needed to TALK about it right from the start, but didn’t, which is why things happened as they did!

    One final thought. She WAS his patient and they DID fall in love and it was all on the up and up. No one seemed bothered by it in the least except that they couldn’t see them together. If she had been able to go to someone else, no doubt they would have agreed on that, especially before marriage. You have said before that Portwenn is NOT at all aware of the world outside so such issues are moot. She would no doubt have wanted him to be her and James’ doctor, knowing that he was the very best doctor they could have.

  2. Santa Traugott

    There seem to be two threads in this conversation. One is how treating professionals negotiate (or don’t) personal relationships with patients, where basically the attraction is one-sided, as in the Mrs. Tishell and DM case. Or if not one-sided, then the relationship begins basically as a professional-patient relationship and then develops into something else. Probably we can put into the mix the relationships that develop between clergy and parishioners.

    I wonder if at the heart of the attraction that patients/clients sometimes develop for their doctors, is the same phenomenon that in psychotherapy is called “transference” — here’s one definition: : ” the redirection of feelings and desires and especially of those unconsciously retained from childhood toward a new object (as a psychoanalyst conducting therapy).” Therapists, especially those who are analytically inclined, find their clients’ transferences very helpful in treatment – — but because these transferences are so strong, and patients quite vulnerable, codes of ethics of mental health professionals forbid personal relationships with clients or former clients. Strictly forbid — as in losing license. There used to be some rule that psychiatrists, e.g., could not enter a relationship with a former patient until 7 years had passed. Of course, these are violated sometimes, (“counter” transference is a phenomenon too, and very powerful). If you met your therapist inadvertently at a party, many therapists would avoid you if at all possible, or if the gathering is small, be very formal with you and in no way indicate that he/she knows you at all. My impression is that the major reason these strictures are so strong is that the “power” differential between therapist and patient is so unbalanced that entering a relationship with a patient is seen as taking advantage of them.

    But the other thread — the relationship between Martin and Louisa — is even more complicated. They did not meet, really, as doctor and patient. They have a romantic interest in each other, but neither is sure it is reciprocated, and so to directly suggest that since they are in a relationship, she should find another doctor, might be seen as presumptuous and taking too much for granted. Louisa gets to this point in the S3 opening episode, and it’s interesting, and even odd, that Martin isn’t shown to pick up on it. This would be tricky to negotiate.

    The part about him wanting to treat her when she was pregnant, and being hurt that she was being seen at Truro — that’s good drama, but I can’t believe in real life, the father of a woman’s child would question her decision NOT to have him be her ob-gyn. As Louisa said, that would be “odd.” But Louisa’s trouble here is not so much with him as her doctor, it’s her assumption, which I think is pretty deeply rooted, that he would not want to be a father, and the fact that he has already told her she wouldn’t make him happy. She doesn’t want him to be forced into a situation where he feels he must marry her and/or be a father to their child. She just doesn’t want him under those circumstances.

    We speculate how different things might have been had Edith not been there and they had been able to have a conversation. I’m not so sure that would have made things much easier. Each of them must have in mind that the other, ultimately, did not choose to be with them, and probably neither wants to suggest that he/she was wrong and maybe they could try again. Maybe because at this point they don’t believe they were wrong, or maybe they’re just afraid. But I think they could have gone on for quite a while, suffering in silence, and not getting any further forward in their relationship. The conflict and the confusion about Edith were what engendered the change of heart and the willingness, on Martin’s part, to finally take a risk, perhaps.

  3. Santa Traugott

    So the important point here being: Louisa was quite right to be indignant when Martin tried to define her feelings for him as “transference.” The doctor-patient relationship was quite tangential to them. And I don’t think she saw him as superior to her — if anything,, she often seemed to think that he needed her help and advice in order to function appropriately in Port Wenn.

  4. Post author

    Santa, we are very much on the same wave length on this subject. Even so, I’m a little uncertain about the transference being of a similar nature to the therapist/patient when it comes to doctors and patients. I say that because therapists have a mission to learn about a patient’s personal history and part of the reason, if I understand this correctly, that psychiatrists find transference helpful is that they need the patient to trust them with very personal feelings. A doctor treating a physical problem needs the patient to be open and trusting too; however, the main goal is to get to the bottom of what is causing the symptoms. As we see in this show, it can be very helpful to know what’s going on at home, e.g. if the patient and his wife are practicing SM sex, or if the patient has a crazy sister who keeps her from taking her medicine. But most of the time the doctor sticks to examining the patient, taking blood samples or urine samples, and running tests of various kinds like EKG or blood pressure. The type of information they want to gather is of a mostly clinical nature.

    There are some really wacky people out there!! They build up their notions from their own imaginations. (I wouldn’t be surprised if actors get some of this sort of behavior too.) If a doctor shows concern and tries to do a good job, like ME often does, he runs the risk of his actions being misinterpreted. He’s not earning the patients’ trust to become a personal part of their lives; he just needs to know enough to help them through their medical problem. Most patients understand this and have no interest in having a personal relationship with the doctor. Then there are the delusional ones.

    In the show Mrs. T, in my opinion, began as a humorous side story. Her husband is gone a lot, she sees herself as knowledgeable in medicine and fulfilling an important role in the community and for the doctor, and, in ME’s case, it’s a great counterbalance to all the townspeople who find him off-putting. Here’s this nutty pharmacist who’s competent in her business and forms a fixation on the grumpy doctor. It magnifies how clueless he is and makes us laugh to see all her unsuccessful efforts to get his attention. The only thing that ultimately works is having a total psychological decompensation and making off with his baby.

    When it comes to Louisa, there’s no doubt that it would be “odd” to have the father of the baby do her regular check-ups and be prepared to deliver the baby. I don’t know many men who wouldn’t be a nervous wreck delivering their own child, and we see how stressed out Martin is when Louisa goes into labor. Could he have delivered the baby? Well, it wouldn’t have been his first anymore, but he isn’t very sure of himself in that department.

    You make a great point that they’ve already agreed they wouldn’t make each other happy. In addition she has no reason to think he would want a child in his life. Edith becomes a pivotal character in that Louisa came back hoping she could have the baby amongst friends, but needed to tell Martin first, and then she sees Edith and the green-eyed monster of jealousy struck. Edith is pivotal for Martin because he realizes how much he wants to be with Louisa. We also shouldn’t forget how much the anticipation of having a baby has had an effect on Martin (or both of them). The scene at the pub when the baby is born shows how much Martin has become convinced that he wants to stay with Louisa.

    I also agree with your final point that Louisa has not seen him as superior to her except, perhaps, in terms of his medical ability. This is the power struggle that is made so central to their relationship. It also makes their interactions more about them personally and not about the doctor-patient dynamic.

  5. Post author

    The example you give of Martin and Louisa misunderstanding each other is another good one of how their communications often slip by both of them. They don’t talk about things because that is the essence of the show — they can’t figure out what to say and how. Or they are interrupted before they can do much talking. One of my reasons for admiring the show is how words are used, or misinterpreted. Occasionally they talk to each other and we have a nice moment, but that’s fairly rare, which is intentional and elevates the show to something better than a simple comedy or drama.

  6. Santa Traugott

    As used in psychodynamic psychotherapy, transference is a very important phenomenon, because it (allegedly) lays out the template for the patient’s reactions to other important objects. People’s way of attaching is repetitive, in a way, and analyzing this attachment can tell the therapist, and the patient, a great deal about the way they function. So, it is powerful, and like much strong medicine, potentially harmful, but it is not discouraged, b/c it is a helpful part of the process. At the same time, it needs to be handled carefully, and above all, analytically, and the therapist must not succumb to countertransference but analyse those impulses within him or herself very carefully, for what they also reveal about the patient.

    I just meant to say that sometimes people inapproriately develop transference relationships in situations which evoke early patterned reactions — as to a doctor, on whom one is dependent, or to a clergyperson, who is viewed as having a certain authority. It isn’t everyone, or even most, but certainly not uncommon.

    Speaking of odd situations, we saw the movie Calvary last night in which there is a scene where the daughter is in a confessional with her father, a Catholic priest (widower, ordained after death of wife). Now that was strange! Although my husband points out that it was just a deep philosophical discussion, and she didn’t ask for or receive absolution. Anyway, I was irresistibly reminded of this discussion!

  7. Post author

    Thank you for the fuller explanation of transference. There’s no doubt that some patients develop transference relationships to doctors and other persons in positions of authority. It may be helpful in a psychological setting and not so much in other settings.

    I’d love to see Calvary sometime. Confessing in any kind of formal way to one’s father has to be really awkward and uncomfortable. The roles we inhabit do cross over at times, and not always in ways we find suitable.

  8. Amy

    I love that there are still posts I’d not seen.

    I also live in a relatively small town, and many of our doctors are also our friends—including the doctor who delivered my second daughter. There is no awkwardness. All of them are very professional about it, never raise our medical issues in public, or discuss other patients. It would be almost impossible for them not to be friends with patients unless they lived miles away and had friends where they didn’t practice.

    And yes, it is easy for a patient to develop affection for a doctor who has helped them through a medical crisis. I know I have felt that way, but nothing that went beyond gratitude and fondness—not like Melanie or Mrs T, but I could see that for some patients who are particularly vulnerable that that could happen. How does a doctor gently discourage those feelings without humiliating or alienating the patient? It must be difficult.

    As for Louisa, I love that episode in S3 when at first Martin is so clueless as to why she wouldn’t want him as her doctor and is hurt by her rejection. Did he really not understand why she uncomfortable with his questions? Especially when he asks her if she could be pregnant? How blind was he to the feelings she had for him (and vice versa)? Had he completely forgotten about his confession of love to her (are we supposed to think he doesn’t remember it because he was drunk)? Or her confession of love to him?

    And I agree with Linda about the closing scene in that episode. I love when she says, “Can I stay here?” and he says, “Of course.” What did he think she was asking? To stay the night? Or just to chat? And her statement that she worries that she doesn’t know what she is doing with her life—it’s probably the first honest emotional thing she has said to him and he gives her an equally honest and almost emotional response. But I digress…

    As for Louisa’s pregnancy and delivery, I thought it was interesting that Martin never tried to take over as the doctor when Louisa was delivering. His usual condescending attitude towards health professionals who are not doctors (the midwife, the herbalist, Mrs Tishell, the vet, etc.) would in most circumstances have led him to push the EMT away and take over once Louisa let him back into the pub, but here he somehow knew his role was to be the father, not the doctor. (Of course, Louisa would have screamed at him if he had tried to deliver the baby….)

    Great post, Karen. So much to think about, but I will stop here.

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