"So. Why did you choose medicine?"
During the first few weeks of medical school, this question came up a
lot in the context of getting to know our fellow classmates. We did
icebreakers, learning one another's stories, sharing our inspirations
and motivations. We heard the huge range of narratives and experiences
that led us here, to the same place, about to embark on the same
journey.
Despite all our differences, I noticed some common themes. One was the
"bad doctor" story.
It goes something like this. I, or one of my loved ones, was involved
a devastating medical situation. We were scared and confused, and the
doctor was just awful; (s)he was cold; (s)he was abrupt; (s)he said
all the wrong things and didn't care about us at all. It was a time
when we were at our most vulnerable, and the person who had the
ability to alleviate some of the anxiety made it worse. The story
always ends with: I wanted to do better than that.
As of two days ago, my first semester of medical school is officially
complete. My classmates and I are one-eighth of the way towards
receiving an MD. Time for a status update. Are we doing better?
In class, we recently had a presentation that involved both a doctor
and a patient. As the session went by, I found myself becoming
irritated by the doctor's interactions with his patient. His
presentation about the science of her illness went on a little too
long, leaving less time for her to speak. He interrupted her. Worse,
he cut her off when she was recounting an experience that made her
emotional, interrupting to remark on the biochemistry of the
mechanism.
Speaking with some classmates afterwards, I found I wasn't the only
one put off by his behavior. Yes – what was with that doctor? Yes; he
was out of line. We didn't need to convince one another of anything.
Independently, we had the same reaction.
Great, we might think. The new generation is better. Perhaps
admissions committees' shifting selection criteria, with an increased
focus on empathy, are working. Perhaps curriculum changes designed to
teach us communication skills and ethics in addition to science are
creating more mindful physicians-in-training.
Still, I find it hard to believe that one heterogeneous group of
people is simply better than another group.
Sometimes, when we are fortunate enough to have patients visit our
classrooms and share their stories with us, a handful of students are
more entranced by emails or text messages. Granted, these students are
the exception, not the norm. And granted, they have been called out.
I've seen another classmate tap one of the computer users and tell him
bluntly to cut it out. Our professors have called them out too, with
one recently saying, "it's very easy to be high and mighty about those
'other' doctors who aren't sensitive to patients... but if you're the
person who's on your laptop while the patient is here telling us about
[his or her] condition, you are that person."
Bad habits start early.
For the rest of us who don't fiddle with our laptops and phones in
front of patients – who were able to recognize "bad" behavior in the
doctor and in our peers – there's still the obvious point that we're
not yet doctors. I realize that it's easy to focus all our attention
on displaying empathy when we're not yet preoccupied with any real
responsibilities. I am aware that our obligations at this point are
minimal; we study, memorize, and pass our exams. We are not
responsible for human lives.
Just wait until we've been doing this for fifty years. I wonder if any
of the "bad doctors" started out like us. Were they once idealistic?
Were any of the people committing empathy gaffes the same ones who
were once able to detect the shortcoming in others? And if so, what
changed? What eroded their ability to display compassion?
Medicine is notorious for jading people. I could see disillusionment
in my own doctor, who talked about how he spent more time doing
paperwork than seeing patients. I could see it in a resident I once
shadowed, who bemoaned the fact that she essentially lost all outside
interests because the only thing she had time for outside of medicine
was sleep. I could even see it in a friend of mine, now just a third
year medical student. Seeing him was especially disenchanting, as I
saw the transition directly; I knew him when, back when he was bright-
eyed.Is becoming disillusioned inevitable?
I am curious to see myself and my classmates – who will then be my
colleagues – several decades from now. Who will retain youthful energy
and idealism? Who will be jaded? And, will any of us be that "bad
doctor" who, by igniting indignation in a patient, unintentionally
helps cultivate the next medical student?
One year ago, while interviewing for admission to a different medical
school, I had the pleasure of speaking with an elderly family
physician. Casually, after our "formal" conversation ended, I asked
him why he ran interviews. "I love seeing the enthusiasm," he told me.
"You spend so much time in this profession, and people complain about
everything… I am inspired by you guys who aren't yet disillusioned."
To that interviewer, I say: I'm afraid I can't promise that I won't
become jaded. I can't promise I won't become stressed. I am sure I
will make mistakes. I am sure I will have many moments that will make
me question whether I am in the right field.
My one hope is that these doubts will never overwhelm my ability to be
kind to patients. The last thing I want to be is a physician who
speaks loudly about moral actions and then behaves regrettably when it
actually matters. And if I ever do become like that, I want someone
idealistic sitting next to me to tap me and call me out on it.
And if by chance, someone reading this happens to be doing so in a
clinical setting, I ask you one favor. Maybe bad habits start early,
but that also means there's more time to fix them. So please, close
this page. There's something way more important right in front of you.
http://www.ilanayurkiewicz.com/2011/12/on-becoming-bad-doctor.html
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