Doctors are just as imperfect as everyone else, but those of us who volunteered for the healer’s role can’t afford to make many mistakes. Our mistakes can cause a patient to stay in the hospital longer. Or they can lead to unnecessary surgery or other treatment. They can cost someone their arm, or their leg, or their eyesight. Ultimately, our mistakes can cost someone else their life. So we tend to focus on self-evaluation, on debriefing ourselves, and on discussing complex or tragic cases with one another so we can all learn. We are taught to constantly ask ourselves what we did right and what we did wrong, to look for areas for improvement. We have little patience for ourselves when we make errors in judgment, especially if they were errors that we feel we should have avoided. Because of this self-evaluation (which can often become self-recrimination, self-punishment, or, as I say, emotional masochism), we are often able to learn from our mistakes and avoid future pitfalls. Because of our tendency to talk amongst ourselves about the difficult cases, we can learn from the mistakes or the challenges of our colleagues. As a wise man once told me, wise people learn from experience, but super-wise people learn from others’ experience.
Notwithstanding our best efforts to evaluate ourselves, physicians still struggle with burnout and cynicism. Right from the beginning of medical school, my professors warned me and my classmates about the dangers of becoming tired and jaded. When interacting with other people, you often see what you expect to see, even if it’s only a shadowy reflection of who the other person truly is. When you base your personal judgments on such a warped, one-dimensional view of another person, you fail to appreciate the complexity and humanity of your fellow man; and when a doctor allows such flawed perceptions to affect medical decision-making, the results can be disastrous.
Even as I reflect on the words I’ve just written, I can’t help being a bit frustrated. If only it were that easy to avoid burnout! But many stereotypes exist because they’re true. And far too often, people present to the hospital as victims of their own poor choices. They become living clichés, and therein lies the crux of the problem: we become jaded because of our experiences, not in spite of them.
Every so often, though, we see a glimmer of light. It’s usually small, but it can be just enough to remind us of the humanity and significance of what we do. I saw one such glimmer during my third year of medical school.
I did my pediatric rotation that year right around Christmas. The attendings were great and the hospital was top-notch, one of the five best pediatric hospitals in America. But the intern to whom I was assigned was awful. She was very passive-aggressive and, worse, she was dishonest. She was the type of resident who would give a student very positive feedback face-to-face, then log into the computer evaluation system and destroy them. (I know. It’s what she did to me.) She showed no interest in teaching, but she treated students like they were stupid for not knowing things. The four weeks I spent with her were truly horrible.
It was during that painful rotation that I broke away from my regular team to spend a week working in the newborn nursery. The hospital was in a major American city with significant socioeconomic problems, and many of the patients came from poor, run-down neighborhoods. Drug abuse was an issue, as was venereal disease. Many of the mothers were very young, had several children in tow, and had only a vague idea who had fathered each. It was a perfect place to become jaded.
Toward the end of my week there, I went to interview a new mother prior to her discharge home. Did she feel safe at home? Yes. Did she have someone to help take care of her other child? Yes. Was she returning to work? No. Did she plan to breastfeed her baby? No, she had HIV. I catalogued all this information to share with my resident (not with the intern from hell). Without thinking about it, I also filed the patient into a mental file cabinet labeled “Social Problems, Probable Drug Abuse.” I then reported to the resident, though I kept my personal judgments about this patient to myself. It’s good that I did.
My resident went to the patient’s room to do his own interview and exam before we discharged this young lady from the hospital. I followed. The resident seemed in very good spirits. He knocked on the patient’s door and we entered.
“You’re ready to go home!” It wasn’t a question.
“Yeah, I’m ready to get out of here,” she replied.
“And just look at your baby,” the resident continued. “He’s a living miracle.”
The new mother just beamed.
The resident turned to me and said words that caught me completely off guard. “I know Ms. Jones here from my continuity clinic. She and her husband were born with HIV. But thanks to modern antiretroviral drugs, they’re both healthy. Now they’ve got an HIV-negative two-year-old girl and a beautiful new baby boy. This whole family is a miracle.”
As we walked back toward the work room, I felt about as small as I’ve ever felt. I had dismissed an entire family as a social disaster, and I could not have been more wrong in my appraisal. Where had I gone so wrong in my judgment? How had I allowed myself to write them off so easily? And perhaps most importantly, how could I keep it from happening again? Those are questions that I pondered for the rest of the day. And I still ponder those questions years later.
I firmly believe the old adage that there’s nothing new under the sun. Many patients are living clichés. But I’ve learned how important it is to avoid mindlessly putting people into little boxes. Behind every complaint, behind every cliché, behind every stereotype is a living, breathing person. And when our prejudices lead us to distill a person down to a stereotype, we can miss that little glimmer of light that reminds us why we do the work we do.
Notwithstanding our best efforts to evaluate ourselves, physicians still struggle with burnout and cynicism. Right from the beginning of medical school, my professors warned me and my classmates about the dangers of becoming tired and jaded. When interacting with other people, you often see what you expect to see, even if it’s only a shadowy reflection of who the other person truly is. When you base your personal judgments on such a warped, one-dimensional view of another person, you fail to appreciate the complexity and humanity of your fellow man; and when a doctor allows such flawed perceptions to affect medical decision-making, the results can be disastrous.
Even as I reflect on the words I’ve just written, I can’t help being a bit frustrated. If only it were that easy to avoid burnout! But many stereotypes exist because they’re true. And far too often, people present to the hospital as victims of their own poor choices. They become living clichés, and therein lies the crux of the problem: we become jaded because of our experiences, not in spite of them.
Every so often, though, we see a glimmer of light. It’s usually small, but it can be just enough to remind us of the humanity and significance of what we do. I saw one such glimmer during my third year of medical school.
I did my pediatric rotation that year right around Christmas. The attendings were great and the hospital was top-notch, one of the five best pediatric hospitals in America. But the intern to whom I was assigned was awful. She was very passive-aggressive and, worse, she was dishonest. She was the type of resident who would give a student very positive feedback face-to-face, then log into the computer evaluation system and destroy them. (I know. It’s what she did to me.) She showed no interest in teaching, but she treated students like they were stupid for not knowing things. The four weeks I spent with her were truly horrible.
It was during that painful rotation that I broke away from my regular team to spend a week working in the newborn nursery. The hospital was in a major American city with significant socioeconomic problems, and many of the patients came from poor, run-down neighborhoods. Drug abuse was an issue, as was venereal disease. Many of the mothers were very young, had several children in tow, and had only a vague idea who had fathered each. It was a perfect place to become jaded.
Toward the end of my week there, I went to interview a new mother prior to her discharge home. Did she feel safe at home? Yes. Did she have someone to help take care of her other child? Yes. Was she returning to work? No. Did she plan to breastfeed her baby? No, she had HIV. I catalogued all this information to share with my resident (not with the intern from hell). Without thinking about it, I also filed the patient into a mental file cabinet labeled “Social Problems, Probable Drug Abuse.” I then reported to the resident, though I kept my personal judgments about this patient to myself. It’s good that I did.
My resident went to the patient’s room to do his own interview and exam before we discharged this young lady from the hospital. I followed. The resident seemed in very good spirits. He knocked on the patient’s door and we entered.
“You’re ready to go home!” It wasn’t a question.
“Yeah, I’m ready to get out of here,” she replied.
“And just look at your baby,” the resident continued. “He’s a living miracle.”
The new mother just beamed.
The resident turned to me and said words that caught me completely off guard. “I know Ms. Jones here from my continuity clinic. She and her husband were born with HIV. But thanks to modern antiretroviral drugs, they’re both healthy. Now they’ve got an HIV-negative two-year-old girl and a beautiful new baby boy. This whole family is a miracle.”
As we walked back toward the work room, I felt about as small as I’ve ever felt. I had dismissed an entire family as a social disaster, and I could not have been more wrong in my appraisal. Where had I gone so wrong in my judgment? How had I allowed myself to write them off so easily? And perhaps most importantly, how could I keep it from happening again? Those are questions that I pondered for the rest of the day. And I still ponder those questions years later.
I firmly believe the old adage that there’s nothing new under the sun. Many patients are living clichés. But I’ve learned how important it is to avoid mindlessly putting people into little boxes. Behind every complaint, behind every cliché, behind every stereotype is a living, breathing person. And when our prejudices lead us to distill a person down to a stereotype, we can miss that little glimmer of light that reminds us why we do the work we do.
No comments:
Post a Comment