The caring doc

When I think of my first two years of medical school, a blur of endless hours of studying and an overwhelming feeling of anxiety permeating the air immediately overtake me and I get a knot in the pit of my stomach. I’m sure I’m not alone. Just ask any physician who wants to remember.  He will concur.

On the first day of medical school, the dean, a stern-looking, elderly gentleman, told us, a class of 200 eager-to-please, mostly male students, that one out of three would not be good enough to finish.

In a strident voice, he instructed us to look to our left and right and keep in mind that one of us, by then panic-stricken, would never graduate medical school.

All that after going through four years of college in premed, taking biochemistry and calculus and watching our friends party and enjoy life while we just worked, hoping to get good enough grades and high enough scores on the MCATs to get accepted into an American medical school, the highest rung of education in the world.

When I think of that not-so-welcoming talk and the stress and dehumanization that defined the first two years of basic sciences that followed, I am never surprised when I watch doctors disengage from themselves and their patients.

Endless hours of lectures in biochemistry, statistics, anatomy, physiology, histology and other sciences, with hundreds of pages of homework, mold the life of the medical student and creates an atmosphere of total immersion into the not-very- user-friendly world of basic sciences. The stress alone is enough to alter the personality of the sweetest, kindest and most altruistic novice.

And that is just the beginning of calculated brainwashing leading to too many of us turning into well-trained robots instead of caring, kind and respectful doctors.

The intentions are good. The better the preparation, the more likely the outcome  will be an excellent doctor, right?  Only partially.

You certainly want a doctor who knows exactly how to treat acute illness in the middle of the night without having to think or look it up when a patient is brought into an emergency room or has an acute episode in the hospital.

You may not really care when it comes to chronic illnesses, though. Your doctor can do some research for your particular situation. In fact, you would prefer that.

Not to mention that a really good doctor must be a healer of the soul and not just a well-trained technician if you want him or her to help you truly get better.

Back to our medical school: The transition to the clinical years did not help us recapture our lost humanity. More studying and more crazy hours continued.

But unlike the first two years, now patients enter the picture.  Training on real people with real problems and needs is the next big step. Suddenly, without preparation or tools for interacting or knowing how to read or listen to people, the medical students start being called doctors.

It’s as easy as that. One day I was Erika, the next Dr. Schwartz. Not a subtle change, not a pause to think about it, not a moment to prepare, just a change in title and voilà, I’m a doctor.

Yes, the training in the scientific areas was and is even more amazing now and above reproach, so why are we not the most wonderful profession?

Let me tell you how we got here .

Public health is where it all began. In the 1700s, when dirt and squalor made the poor sick and constant victims of epidemics of infectious diseases, hospitals were created to treat them.

Medical schools sprung up near the hospitals because the poor and sick did not question a medical student’s care, and they were fertile ground for teaching. We learned to help large populations, isolate the sick, treat them with drugs and operate with anesthesia.

Public health became standardized health in the mid-20th century and that’s where we got stuck.

We created a system in which standardized health is what is taught in medical schools and practiced in our hospitals and clinics.

Automatons with a deep knowledge of science and little understanding of individuals took their place in the line of doctors trained in the most up-to-date methods, fully supported by science and evidence-based medicine.

Our vocabulary alone became something to stand in awe off.  It’s like a foreign language to separate us from the rest.

One more odd thing: Medicine is the only profession where trust is automatically given to its graduates the moment they receive their MD or DO without question or need to prove themselves in any way. Pass your tests, your boards, finish school and that’s all you need to have dominion over peoples’ lives and deaths

I’ve been baffled by this situation for years and have written much about it. How can anyone blindly trust another person whose only difference from you is that he has an MD or DO after his or her name? How does that give anyone insight into another human’s feelings or body functions? It doesn’t.

And so it goes that from youths full of desire to save the world and be doctors, people ready to dedicate their lives to saving others, so many of us fall short simply by losing that core of humanity and care that defined us at the start.

As the years have passed and I have become a real doctor, maybe only about 20 years now, I watch the same process unfold.  I stay in touch with my alma mater, I am the president-elect of the board of managers at my medical school, I watch and meet with medical students and even was a member of the curriculum committee.

Not much has changed. There is a union now representing the interns’ and residents’ needs, helping them request and obtain more humane working hours. There is more awareness and a push to humanize medical education. But at the end of the day, not much has changed.

Those who really care about their patients have to get there by working their way through classes where your instructors tell you that emotional involvement with the patients is a recipe for disaster, that objectivity does not go hand-in-hand with care and personal involvement.

For me, that doesn’t work.

I am a good doctor. And I know that what makes me a special doctor is my deep love for my patients. My empathy for their suffering and my care for them is where I am strongest. I know my patients and they know me. I practice individualized medicine.

All my patients are unique and our relationships are special. I am well-trained but my training and experience are only as good as the last patient I made well.

The next time you go to the doctor, watch him or her. If he makes eye contact with you, listens to your story and does not keep his nose buried in the chart or the computer screen, if he asks you about your family and remembers when your last kid was born, stay with that doctor. He or she has taken all the good from their standardized training, hasn’t gotten swept up by the ego-loving title and has added personal humanity to the recipe for your care.

That doctor will be the right and only partner for you.

For more information, email Dr. Erika at Erika@drerika.com.

 

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