In the May 28th issue of JAMA the “A Piece of My Mind” feature is titled “In Defense of Phobias“. Rosenbaum concludes with the following:
I hope that you all experience many times the opportunity to participate in an action or a decision that could do harm to a patient. These activities are an unavoidable component of medical care. And if you fear that participation, do not lose your fear. Instead, remember that our profession seeks to extend the quality and quantity of life, but the effort to conquer illness will always bear inherent risk. Be afraid, because that fear makes you more human, and greater humanity makes you a better physician. Be not so afraid that you cannot take action, but not so confident that you forget the potential consequences of that action.
This really rang true for me. I’ve commented before on the awe that I believe a physician should maintain for the trust extended to him by his patients, but I really don’t think enough can be said about it. At least, I never feel like I’ve completely come to terms with it myself.
Rosenberg uses as an example in the article the unease, or fear, that a physician may feel just before inserting a needle into a patient’s eye to administer treatment. Even if that treatment is the best hope of saving the patient’s vision, even if it is the two-thousandth time the physician has done it, doing this should give a person pause. The fear should be felt by the physician because it is likely being felt in a much greater degree by his patient. The ability to sense that fear, to feel it a little with the patient helps us to keep proper perspective as we attempt to help our patients solve the problems they bring to us.
That fear will help us avoid arrogance. It will help us maintain humanism in our relationship to our patients. That discomfort that we feel when considering if the potential benefits of a treatment justify the risks will help us remember that our patients are considering the same balance, though usually without the specific education and experience the physician will have to inform that decision.
I understand that not every patient we see will need a treatment that is really risky, most of them won’t. Not feeling fear when working with those patients is fine, because the patient probably isn’t feeling much fear.
I have no delusions that every decision I make as a physician will be earth-shattering in some way, but I hope I never forget that some decisions I make will be earth shattering, and that I’ll feel a little of the shudder.
