In Physician Apprenticeship, which is a fantastic program in medicine that pairs small groups of us with senior medical students and a practicing physician (we have a wonderful general surgeon as our mentor), the point is to have meaningful conversations about the human aspects of being a doctor outside of medical facts and diagnosis. I see it as a safe place where I can discuss my fears, frustrations, and struggles with the medical program, and learn from the amazing stories (both rewarding and horrifying) of my senior colleagues, which show me what I get to look forward to: once we get through these lectures, we get to go into the hospital and actually practice medicine and contribute to saving lives.
Until then, Physician Apprenticeship is like a delicious taste of the world that we will get to be part of, the carrot that keeps us moving.
In our last meeting, we watched a couple of clips from the tv show ER (this is part of why I love this course so much: we get to watch tv!), and we discussed a couple of scenes at length. One scene was a young resident spending hours of his personal time connecting with a pediatric patient who had cancer and was taking out his frustrations on his older sister, who seemed to be the sole caretaker of the young boy. For me, the scene was about whether or not it was appropriate for the young doctor to take hours (during his time off) to play video games with the patient, bond with the patient, and eventually tell the young patient a very personal story about his experience with his own brother’s cancer, and how his brother lashed out against his relatives as well.
This simple clip opened up many topics of dialogue. For me, I tried to articulate to the group that I don’t think that a doctor should be expected to do what the young doctor did, because the doctor’s goal was to mend the patient’s relationship with his sister, which didn’t directly treat the cancer (the way that chemo and other treatments can), so if every doctor was expected to heal families as well as the patient’s specific disease, then wouldn’t that take up every hour of a doctor’s day? (Plus, wouldn’t psychiatrists then be out of jobs?!!) I didn’t feel like it should be part of the job description for a doctor to spend all his free time with patients or wear the doctor hat all the time.
But my argument was, at best, incomplete. I couldn’t quite articulate my intention without sounding like I don’t care about patients other than their disease. The truth is, if you ask me whether I would have done exactly what the young resident did? The answer would be yes without hesitation. The reason why I want to go into psychiatry is because I believe in the power of perspective: how changing the way we think about a disease or situation changes everything about it.
A poignant example of what I mean is this 3-minute TED Talk by Stacey Kramer on the best gift she has ever received, and how perspective played a big role.
I believe that the ER doc was being a phenomenal doctor by trying to treat his patient’s poor relationship with his sister, because his relationship with his family and how much he lets his family support him affects everything from how willing he is to get treatment, to how adherent he will be, to what attitude he will face his cancer with, all of which have tremendous effects on how well the treatment will work. In that light, isn’t the ER doc doing exactly what his job is as a doctor? Well, kind of. So isn’t that shooting myself in the foot?
Well, it took me a long time to clarify my frustration with the entire process, but finally, I think I realized that the issue for me is the difference between wanting to do something and being mandated to. My frustration isn’t with what the ER doc did, or even with med school’s noble intent of producing doctors who care about patients holistically. My disagreement lies with the method med school uses to try to teach empathy. I finally understand that the reason I don’t think a doctor should be expected to do what the ER doc did is because a mandate like that would not produce effective doctors that actually care about the patient – only doctors that pretend to care for the sake of doing their job, which is arguably worse than a doctor who doesn’t try to fake it. My issue with these types of classes in medical school is that (as a dear friend expressed to me) I don’t think we can teach empathy. Ultimately, I have no problems with what the doctor in ER did, and I would have done the same thing if it meant being able to heal a patient holistically, but my biggest concern, now that I’ve had time to reflect upon it, is that these courses seem to strive to teach an intangible quality, and I fear that all we can accomplish is teach how to act empathetic and caring without the true substance or intent behind it.
Fortunately, I don’t think my classmates lack empathy (thanks, in part, to the change in the way med school interviews are done), so for the most part, I think these courses will help us refine and clarify our empathetic powers. I guess my fear with watching and discussing these clips is that it will promote one ideal for what being a “good” doctor is like, and it will encourage us to act in certain ways just to impress or to “do the right thing” even though in our hearts we disagree with the action. I think the key is to understand the ER doctor’s intention of healing the patient as an entire human being. Once that is understood, I think the exact course of action that a doctor takes to heal a patient is an extremely individual choice.