The gift of the benefit of the doubt.

I have friends and colleagues that naturally grew up with the mindset of giving everyone the benefit of the doubt.  I’m not sure why I didn’t, but I used to often assume the worst about others.  I didn’t even see it as a problem until I was in training. 

Thankfully, I began to learn to give patients the benefit of the doubt during training. By way of example, I experienced my fair share of narcotic seekers and manipulating who wanted to either abuse medications or divert prescriptions for money. Cynicism reared its head early; however, I had key faculty, colleagues, and patients that taught me some important concepts. 

One lesson was that some patients do a bit of over-acting as a preemptive tactic.  They fear they won’t be believed and will be dismissed, so they exaggerate.  I particularly remember this in a few patients of our large population of patients with sickle cell disease needing admission for a severe acute pain crisis. Dr. Johnson Haynes was skilled at seeing our automatic cynicism and bias that started early in training. He carefully and firmly broadened our understanding of patients in a pain crisis. He taught us objective ways to evaluate the situation, and he taught us compassion. He helped us understand that this population had been labeled and dismissed in the past. He helped us see those exaggerations as appropriate pain-seeking behavior by patients who are afraid of being dismissed again. They wanted to convince us how much pain they were in. And, of course, he taught us that patients express pain differently. (Please note, we used objective measures and appropriated used opioids in severe, acute pain crisis. I’m not advocating treating all pain with narcotics). 

The second lesson was that patients wanting an ‘escape’ were human and could benefit from my training in other ways. Several of our core family medicine faculty were skilled in mental health and compassion. I inherited a patient with years of back pain. On her chart (paperback then) was a big note advising “no controlled substances.”  She developed chronic nausea (for which she received a thorough neuro, endocrine, and GI evaluation) and was always wanting sedating nausea medication and/or muscle relaxers. She knew she couldn’t get controlled substances from us. It became apparent that she wanted anything to help with a mental escape, which these medications offered. During the early cynical years, it was easy to assume the worst – she was just a manipulator wasting my time. With perspective from faculty, however, I came to see the benefits when I opened to the possibility that she wasn’t just a conniving person taking advantage of the system. After an open and direct discussion, she admitted that sedating medication was her way of coping with her financial and social situations as a single mom with young kids. She didn’t want to use alcohol or illicit drugs but felt prescriptions were acceptable. We were able to get her mental health access and social work, and she began to improve before I graduated.  (It’s worth noting here when I assumed the worst, I categorized her as someone who didn’t need to be in my office. Giving her the benefit of the doubt that she did need to be seen didn’t mean I gave her what she thought she needed. But it meant I looked for ways to help).

Although I had expanded the benefit of the doubt to more patients, I was still blind to the fact that I didn’t easily give it to everyone else in life. There may have been even a preemptive motive for me to assume the worst to avoid being surprised with disappointment or the feeling someone had taken advantage of me.

One day I was having a conversation with my wonderful friend Connie. She answered in reply to some insignificant comment that I don’t really recall, “You know I find it’s best just to give people the benefit of the doubt.” If you met her, you would know she’s gentle in teaching lessons but has a wealth of wisdom to share. I recognized that her comment was for me to ponder more deeply and broadly. So, I began to think about how giving the benefit of the doubt aligned with my core values of being kind and generous. I began to have some growth in that area as an external gift to others, even though they never could see it.

Finally, in my coaching journey, I have an even larger appreciation of giving the benefit of the doubt that seemed paradoxical in the beginning. The realization that giving someone the benefit of the doubt, even if they proved that they weren’t worthy of my trust, didn’t really have a downside. Now, let me be clear. I’m not talking about all transactional situations. I’m not saying, if someone sends you an email that you just won 1,000,000 dollars and all you have to do is give them your bank account info for a deposit, you should give the benefit of the doubt and buy-in. But I’m talking about most mental situations. By assuming the best intentions of someone else, I get a net positive experience for myself even if I am wrong. There’s less frustration, anger, suspicion, and more love, contentment, and ease. I don’t even need to know if I was right or wrong. My life is better. 

I demonstrated this to one of my resident clients. He had an encounter with an attending that certainly could be interpreted in multiple negative ways. “He’s on my case.” “He thinks I’m a terrible resident” “He is out to get me.” “He basically told me everything I’m doing is wrong.” “He chastised me.” The resident ruminated on it for over a week and avoided the attending. I had him tell me exactly what happened during the interaction. He said, “The attending asked me why I thought this was the best course of action and could I back it up with evidence.” When we really broke down the facts from the meaning he was giving to those facts, he slowly became open to a possibility that he could be wrong about the attending’s intentions. We reviewed what the previous week would have looked like had he just accepted the attending had good intentions. He admitted there would have been less suffering. I took it a step further. What if he gave the benefit of the doubt to the attending and then later somehow found solid evidence that the attending was “out to get him?”  He still saved himself several days of anguish. And upon discovering it, he would still have the choice to feel angry and frustrated or even to decide to let it go if he felt it would serve him better. 

And so, it turns out, giving the benefit of the doubt is often not only a gift to others but to ourselves.

Have a joy-filled day!

Tonya

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