Medicine, for the Love of Humanity
- Feb 28, 2018
Most of us choose a career in medicine for the right reasons. We do it because we want to help people and there is no cause nobler than decreasing or eliminating unnecessary suffering. Unfortunately, the daily grind of the profession itself sometimes makes us forget about the original purpose of our chosen profession.
Studies of medical trainees show that burnout is extremely common, with 28-45% of medical students and 27-75% of residents experiencing burnout. Seasoned physicians do not fare any better. One of the key features of burnout is depersonalization, which involves negative, callous, and detached responses to others.
So the question is: if many of us are burned out before we even complete our medical training, how do we get our humanity back? How do we treat patients the way they want and need to be treated as people? How do we treat our patients the way we imagined treating them when we chose to be doctors in the first place?
There is no doubt that part of this problem is systemic and needs to be dealt with in a systematic way. Reform is necessary to both medical training and the medical system in general. But what do we do while we’re waiting for the inevitable change that is coming? I don’t have all the answers, but I do have a few suggestions.
Take Stock of Important Moments:
I remember very clearly my first rotation in my third year of medical school. It was my general surgery rotation and I was with the trauma surgery team doing both trauma surgery/ICU and general surgery. It was a very stressful time.
Beyond the lack of sleep and the very sick patients, there was the fact that at any moment I had to be in the trauma bay ready to do my job as a medical student. At the time this included the “3 Fs”: the femoral stick, the foley catheter, and rectal exam (the 3rd f was for finger). That meant sleeping with my shoes on with a phone next to my ear. Needless to say, I didn’t get much sleep. Some of the students on the rotation loved it. For me, it was torture (one of many reasons I became a family doctor). I can remember very clearly one night six weeks into the rotation at about 3am, we received a trauma alert, which was a gunshot wound. The paramedics brought in a young man with a single gunshot wound to the abdomen. He was pale and his pupils were fixed and dilated. He had no pulse and it was apparent he’d been that way for at least several minutes. The surgeon on call called his death within 2 minutes of his arrival. All I could feel was relief that I could go back to sleep.
I don’t know how the others felt. I think what I felt was probably normal. We were all sleep deprived and had gotten used to seeing gunshot wounds as well as all manner of injuries, including: stab wounds, motor vehicle accidents, and falls from high places. Anyone can get numb to these types of experiences.
What I think is important is to take stock when you realize it is happening. I had just seen a man in his 20s whose life had been cut short. I should at least feel something. When you stop feeling anything at the senseless loss of life or suffering, it is time to take stock.
Listen to Your Patients:
I remember another anecdote from when I was a medical student. I was rotating on the OB/GYN service. It was a clinic day and a mother of four in her late 30s came into the office for a consultation for a tubal ligation. She and her husband were very happy with their family and they had chosen this method for long-term birth control.
The attending explained the surgery in detail and then asked if the woman had any questions. “Well I understand all that, but it all just seems so… final,” she said. The attending looked up with a confused look and proceeded to run through the mechanics of the surgery again before running out the door to see another patient.
I stayed behind and talked to her for just a few minutes. We discussed the feeling of no longer being able to have children and how she felt that, in a way, it defined her as a woman. She said she knew she still wanted the surgery, but it was just difficult to wrap her head around it. I told her that, like all things, it would take time getting used to. She seemed to feel somewhat better just from being heard, and I left. The point of this story is to listen to your patients, as sometimes what they need is not just your medical expertise.
The Little Things:
As in the previous story, it’s often the little things that will not only make your patient feel better, but will also help you preserve your own humanity. Research shows that simply sitting instead of standing gives patients the impression of a longer visit and a more positive experience with their physicians.
Another technique that is often taught in the medical interview is mirroring. This consists of repeating back to your patient what they told you in your own words. Again, I find the act of repeating what they told me helps me understand better what they are going through.
Lastly, as a primary care physician, I learned early on that making eye contact with my patients was paramount to not only making them feel heard, but also for me to properly hear them – to understand what they were going through.
One of the biggest downsides of EHRs is that they encourage us to look at the computer during the medical interview. I know it’s difficult, but I think it’s very important to make eye contact during at least part of the patient encounter.
Getting Help When you Need It:
One of the most important things you can do, of course, is to get help when you feel that you are past the point of just mild burnout. If you are so worn down that you are not feeling anything when treating patients or you begin to feel like an automaton, it is time to seek out help for yourself. This might mean talking to friends or mentors, or it might mean seeing a mental health professional. Each case is a little different.
It is easy to get caught up in the day-to-day grind and in the stresses of our jobs. In the end though, we are doing our patients and ourselves a disservice by forgetting our humanity.