"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.
In just two months, my first year of medical school will be complete. Time for a status update. Are we doing better?
A few months ago, we had a class 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 one of my own doctors, 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.
(From the archives: a slightly modified version of this post was originally published on December 18, 2011, on Unofficial Prognosis’ former website.)