Do you know your doctor?
“If I hide myself wherever I go, am I ever really there?” Bare Naked Ladies, For You
So, I really like the above song by the Bare Naked Ladies. I like to listen to it while I run, for some reason, it just fits my running. Listening to it today, I realized how applicable it is to situations not specifically implied by the song. Situations like practicing medicine.
We take a “Physical Diagnosis” class as Medical Students here, and the first topic they focused on was what they call the “Crisis in Medical Professionalism.” Our small-group preceptor summed it up well by saying that the take-home message from this part of the course is, “Don’t be a jerk.” We read a lot of things that talked about doctors and the common cynical and misanthropic views they have towards patients, the passing of those attitudes on to medical students, and the effect those attitudes have on the patient experience. Generally it boils down to this: Doctors have the job not just of conquering disease, but of healing their patients. This difference is illustrated in the medical care of a patient with terminal disease. The doctor isn’t going to conquer the disease, but he can provide healing for the patient by helping the patient manage his disease and maintain the best quality of life possible for his situation.
The papers we read indicated that this can only really be done when the doctor allows himself to connect with his patients, when he views his patients as people and not just medical problems to be addressed (the difference between thinking of a patient as “Mr. Smith with the ankle problem” and thinking of him as “The Ankle”). The attitude of a physician, including this aspect of that attitude, is at least sometimes going to be evident to at least some of his patients, regardless of how good of an actor he is. A patient who feels hostility, cynicism, or disinterest from his physician is not going to feel comfortable opening himself up to the doctor, and thus will not be able to receive any true healing (which has mental, emotional, and physical parts) from the physician, not to mention that cynical physician is less apt to try to provide that healing.
I agree with all of this, and feel that this disconnection between patients and physicians often stems from the physician building a wall between himself and his patients. It may be a glass wall, or even a thin fabric wall, rather than a brick or steel wall, but it is a wall. Physicians do this to protect themselves, and try to maintain emotional stability. I believe (though I will admit that I’m inexperienced at this point) that the need to protect one’s self from a patient stems from a poor approach to medicine in general, one that places the patient in the position of being an adversary or threat to the doctor. But why would a doctor need to defend himself against his patients emotionally (perhaps legally, sure, but emotionally?) I don’t know anyone who goes to the doctor with the intent of assailing his emotional health. People go to the doctor for help, sometimes they go to the doctor because of minor physical complaints because they are really seeking emotional care. Why would a physician feel the need to, even partially, close himself to sensing this need and attempting to provide for it?
It’s a discouraging thing for me to see physicians in their practices feel so unfulfilled without seeing that they are closing the doors to fulfillment by distancing themselves from their patients. We become physicians because we want to help people, at least, I hope that’s at least part of why we become physicians. How effectively can we help someone we view as an enemy though?
Satisfaction, I think, comes from treating patients, not disease. Treating disease is a losing battle, as new diseases appear, old remedies fail, and each line of understanding reveals multiple new avenues of questioning, we cannot hope to even keep up, let alone master or destroy disease. We can, however, win the battle when we treat patients, because each patient we see presents us with a new opportunity to heal, a new chance to succeed. I may never be able to cure HIV, but I can help a patient with HIV have a satisfying quality of life. If that’s my aim, then I’ve won, and I’ve received satisfaction as my reward. If I fail to help my patient, which I will sometimes do, then I do receive some pain, but I also learn, and it truly is the sum of our pain and our pleasure, our grief and our joy, that makes us who we are.
In the end, it begs the question: Are we ever really treating them, or are we just treating disease? If we hide ourselves from our patients, if we build walls to protect us, if we approach our patients as threats to our emotional health, are we ever really there?
