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What Really Matters in Medicine?

The writing is on the wall. Though most things in this field happen slowly, there is a noticeable trend away from test scores and towards empathy and humanism in medicine. With burnout consuming the field in addition to a staffing crisis, it only makes sense that some of these “softer” skills become more important.

When we ask “what really matters?” in a field focused on caring for patients, the answer is easy to deduce: it’s about the people. But how do we bring more humanism to medicine going forward?

Focusing on care, not exam scores

Pretend you’re a patient suffering from pneumonia, or perhaps a run-of-the-mill GI bleed. Do you care if the doctor prescribing your azithromycin (or transfusing blood) and rounding on you graduated from Harvard Medical School or not? Is it important to you if they scored a 250+ on Step 2 CK? The uninitiated don’t know what Step 2 CK is. They will hope that their doctor “passed boards,” but the class ranks and grades and USMLE scores are the least of their worries.

What does your patient really want? Someone who can give them the right diagnosis, prescribe the right treatment, and treat them like human beings with dignity, instead of seeing them as a disease process.

The tricky element here is that exam scores can improve, but it’s more difficult to change attitudes and personalities. The recipe for better academic performance has been pretty well tested and proven: study more, get a tutor, and make sacrifices in other parts of your life to devote more of yourself to internalizing material. If you focus the totality of your efforts on getting better grades and higher scores, you will certainly improve.

Shifting your mindset

As Ke$ha reminds us, “We R Who We R.” With each passing year, we become more set in our ways. While there is some neuroplasticity and the ability to change our demeanors, by the time we begin our medical education, we have crafted our personalities and values for a few decades. 

That’s not to say that people don’t change. Your medical education in and of itself will likely have big effects on the person that you are, and the person you will become. But it’s rare to go from a jerk to a delight, or from a mensch to a misanthrope. Cultivating humanism can be a tricky prospect, but it can be done.

What does this mean for you? Your future will depend more on your interpersonal communication skills, and how well you work with others, much more than it will depend on whether or not you broke 245 on an exam a decade ago because you remembered where carbon atoms got recycled in the Krebs cycle.

Ergo, spend some of your time devoted to these avenues, instead of putting every single ounce of yourself into studying. 

Fostering humanism in medicine

Much has been written on this topic, especially as of late. But the way I best saw it all summed up into a single cue was as follows:

“Just trying to put myself into their human being shoes.”

At the beginning of our medical training, we usually have so many medical-related thoughts, and so much of our focus is on the science and differential diagnosis and history taking. But as the training becomes more ingrained in us, the mind space opens up to allow our consciousness to focus on being human in our patient interactions. 

When you are free to do so, don’t think of your patient as a disease, or even as someone with a disease. Just assume their perspective as a human being. In other words, don’t think of them as a “lymphoma patient,” think of them as Mr. Jones who has a wife of 40 years, loves golf, and finds no greater joy than throwing around his grandkids. He wants to get back to all those things, and it’s your job to get him there.

Developing interpersonal skills

The focus on humanism in medicine isn’t just limited to patients. It’s about how you interact with your team, too.

A phrase that comes up a lot at the hospital is “playing nice in the sandbox.”

Why did Dr. Gupta leave? 

“Oh, he couldn’t play nice in the sandbox.”

No matter how “great” you are at your job, and no matter how much training you have, you’ve got to find a way to work nicely with other people. You don’t need to buy the entire team lunch every day. You just need to be a neutrally cordial human being. That’s where the bar is set. Naturally, your day and the days of everyone around you will be more enjoyable if you can hit the high marks of “friendly” and “engaging.” 

Denigrating others, or harboring an attitude of pretentiousness is the way to bring down those around you. Another bad habit to avoid: airing dirty laundry in the breakroom. This will only bring down everyone’s mood and do very little to elevate yours. Morale is contagious, so keep it up.

In a perfect world, take an active interest in the outside lives of your colleagues and mentors. Know their kids’ names, and familiarize yourself with their hobbies. It’s no coincidence that it all comes back to humanism. That masked woman over there isn’t just your scrub nurse. She’s Katie, and she spends her weekends going to her son’s baseball games and loves going to concerts. 

If this all comes as second nature to you, all the better. I have little to offer other than “stay the course.” But if some honest self-reflection tells you, “I could afford to be a little more empathetic and caring,” take some time and effort to up your humanism game. As usual, your patients will be better off for it.

Further Reading

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