Tag: empathy

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Clinical Emotion General Humour Lifestyle Literature Medical Humanities Narrative Reflection

On Playing Doctor

An excerpt from “Playing Doctor: Part Two: Residency”

By: John Lawrence, MD

As was her habit, she [the surgical chief resident] had called to check in with a surgical nurse to see how each of her patients was doing. They were discussing each patient when the nurse stopped to mention that there was a code team outside a room on the sixth floor with a collapsed patient.

My girlfriend quickly realized that it was one of her patient’s rooms, then raced back to the hospital, sprinted up six flights of stairs, and dashed onto the sixth floor, where she encountered a chaotic group of people surrounding one of her patients lying unconscious in the hallway.

The internal medicine residents and attending physician running the code were about to shock the unconscious patient because he had no pulse. As we’ve discussed previously, no pulse is bad.

Suddenly, in the middle of their efforts, and much to everybody’s surprise, the 5’1” surgery chief ran up, injected herself into their midst, ordered them to stop, and demanded a pair of scissors.

Nobody moved. The internal medicine attending exploded, wondering who the hell she was and what she was doing. It was his medicine team in charge of the code, and this patient had no pulse. Protocol was shouting for an immediate electric shock to the stalled heart.

Paying little or no attention to his barrage of questions, she grabbed a pair of scissors and now, to everyone’s complete and utter shock, cut open the patient right through the surgery wound on his abdomen.

Let me recap in case you don’t quite appreciate what’s going on: she cut open a person’s abdomen in the middle of the hospital hallway—and then stuck her hand inside the patient!

When the chairman of surgery came racing down the hall, he found his chief resident on the floor wearing a full-length skirt, with her arm deep inside an unconscious patient, asking, “Is there a pulse yet?”

The furious medical attending was shouting, “What are you doing? Are you crazy? What are you doing?”

And she kept calmly asking the nurse, over the barrage of shouts and chaos, “Do you have a pulse yet?”

Suddenly the nurse announced, “We’re getting a pulse!”

Which immediately quieted everyone.

Being an astute surgeon, she remembered thinking that the patient’s splenic artery had appeared weak when they operated on him. She correctly guessed that the weakened artery had started bleeding, and that his collapsing in the hallway was due to his rapidly losing blood internally. She had clamped the patient’s aorta against his spine with her hand to stop any further blood loss.

From the sixth-floor hallway the patient was rushed to the O.R. with my girlfriend riding on top of the gurney, pressing her hand against his aorta, keeping the guy from bleeding to death.

She then performed the surgery to complete saving his life.

The guy took a while to recover. Being deprived of blood to the brain had its detriments; when he awoke, he was convinced the 5’1” blond surgeon in the room was his daughter. When he was informed that no, she wasn’t his daughter, he apologized, “Sorry, you must be my nurse.” That comment, one she heard all too frequently, did not go over well.

To put this somewhat crazy event into perspective, within a day or two, the story became the stuff of legends told throughout surgical residencies across the country—and this was before social media sites existed to virally immortalize kitten videos.

Opening a patient in the hallway and using her hands inside the guy to save his life? This feat, treated by her as nothing more than a routine surgical moment, was akin to knocking a grand slam homerun in the ninth inning of the World Series in game seven to win the game—well, something like that. It’s what little kid wannabe surgeons would dream of if they cultivated a sense of creativity.

And to be fair, I thought it was an exciting episode, but she was always running off to save lives as a surgeon. The moment however, that finally put this accomplishment into perspective for me occurred when I was having dinner with her brother, the ace of aces surgeon, along with several other all-star surgical resident friends. This was a few weeks later, and without her present.

Eventually their surgery discussions (because that is pretty much all that this group of surgeons discuss when stuck together: surgery, ultra-marathon running, and more surgery) turned to loudly bantering back and forth about the whole event.

They boisterously argued about how much better they would have handled the whole situation, and wished they had been there to save the day instead of her:

“You dream of something like that going down.”

“Can you imagine being that lucky?”

“Should have been me.”

“Oh man, I would pay to have something like that happen.”

All the young surgeons agreed that this was their medical wet dream, being the rebellious action hero, on center stage, in such a grand case, in the middle of the hospital, no less, calmly saving a life in front of everyone with attending physicians yelling at you.

Then there was a moment of silence, total quiet as everyone reflected on the event…

“But you know what?” her brother finally said, looking around at everyone, then shaking his head and chuckling, “I never would have had the balls to do it.”

And every single surgeon around the table slowly nodded their head in agreement—they wouldn’t have either.

True hero.

Playing Doctor: Part Two: Residency is a medical memoir full of laugh-out-loud tales, born from chaotic, disjointed, and frightening nights on hospital wards during John Lawrence’s medical training and time as a junior doctor. Equal parts heartfelt, self-deprecating humor, and irreverent storytelling, John takes us along for the ride as he tracks his transformation from uncertain, head injured, liberal-arts student to intern, resident and then medical doctor.

Categories
Clinical Community Service Emotion Empathy General Healthcare Disparities Opinion Public Health

Let Me Be Brief: Community Leadership

A series of briefs by Texas Medical Students

By: Fareen Momin, Sereena Jivraj, and Melissa Huddleston

In the ever-evolving field of medicine, it is no surprise that the idea of leadership in medicine has changed over the years. Some physicians have engaged in additional leadership in the context of politics. In fact, several physicians signed the Declaration of Independence.1 Today, physician community leadership extends much further. Physicians can engage with their communities and beyond via virtual platforms. Physician “influencers” use social media to provide quick answers to patients, and physician-patient interactions on Twitter alone have increased 93% since the onset of the COVID-19 pandemic.2 With physician voices reaching ever-larger audiences, we must consider the benefits and ramifications of expanding our roles as community leaders.

Medicine and politics, once considered incompatible, are now connected.3 There is a long list of physician-politicians, and community members often encourage physicians to run for political office, as in the case of surgeon and former representative Tom Price.4 Physicians are distinctly equipped to provide insight and serve as advocates for their communities.5 Seeking to leverage this position, a political action committee (PAC), Doctors in Politics, has an ambitious desire to send 50 physicians to Congress in 2022, so they can advocate for security of coverage and freedom for patients to choose their doctor.6-7 There are dangers, however, when physicians take on this additional leadership role. For example, Senator Rand Paul (R-Ky.), an ophthalmologist, has spread medical misinformation, telling those who have had COVID-19 to “throw away their masks, go to restaurants, and live again because these people are now immune.”8

It is not practical for even those medical students who meet age requirements to run for office. What we can do is use our collective voice to hold our leaders accountable, especially when they represent our profession. We can create petitions to censure physicians who have caused harm and can serve as whistleblowers when we find evidence of wrong-doing perpetrated by healthcare professionals. We can also start engaging in patient advocacy and policy-shaping with the American Medical Association (AMA) Medical Student Section and professional organizations related to our specialty interest(s).

To avoid adding to confusion, statements by physicians should always be grounded in evidence. Dr. Fauci’s leadership is exemplary in this regard. He has worked alongside seven presidents, led the National Institute of Allergy and Infectious Diseases (NIAID) since 1984, and has become a well-known figure due to his role in guiding the nation with evidence-based research concerning the COVID-19 pandemic.9 Similarly, Dr. John Whyte, CMO for WebMD, has collaborated with the Food and Drug Administration (FDA) to advocate for safe use of medication and to educate those with vaccine apprehension.10 Following these examples, we should strive to collaborate with public health leaders and other healthcare practitioners and to advance health, wellness, and social outcomes and, in this way, have a lasting impact as leaders in the community.

  1. Goldstein Strong Medicine: Doctors Who Signed the Declaration of Independence. Cunningham Group. Published July 7, 2008. Accessed February 2, 2021. https://www.cunninghamgroupins.com/strong-medicine-doctors-who-signed-the-declaration-of-independence/
  2. Patient Engagement with Physicians on Twitter Doubles During BusinessWire. Published December 17, 2020. Accessed February 2, 2021. https://www.businesswire.com/news/home/20201217005306/en/Patient-Engagement-with-Physicians-on-Twitter- Doubles-During-Pandemic
  3. WHALEN THE DOCTOR AS A POLITICIAN. JAMA. 1899;XXXII(14):756–759. doi:10.1001/jama.1899.92450410016002d
  4. Stanley From Physician to Legislator: The Long History of Doctors in Politics. The Rotation. Published May 15, Accessed February 2, 2021. https://the-rotation.com/from-physician-to-legislator-the-long-history-of-doctors-in-politics/
  5. Carsen S, Xia The physician as leader. Mcgill J Med. 2006;9(1):1-2.
  6. Doctors in Politics Launches Ambitious Effort to Send 50 Physicians to Congress In 2022. BusinessWire. Published May 27, 2020. Accessed February 2, 2021. https://www.businesswire.com/news/home/20200527005230/en/Doctors-in-Politics-Launches-Ambitious-Effort-to- Send-50-Physicians-to-Congress-In-2022
  7. Doctors in Accessed February 2, 2021. https://doctorsinpolitics.org/whoweare
  8. Gstalter Rand Paul says COVID-19 survivors should “throw away their masks, go to restaurants, live again.” TheHill. Published November 13, 2020. Accessed February 2, 2021. https://thehill.com/homenews/senate/525819-rand-paul-says-covid-19-survivors-should-throw-away-their-masks-go-to
  9. Anthony Fauci, M.D. | NIH: National Institute of Allergy and Infectious Diseases. Published January 20, 2021. Accessed February 2, 2021. https://www.niaid.nih.gov/about/anthony-s-fauci-md-bio
  10. Parks Physicians in government: The FDA and public health. American Medical Association. Published June 29, 2016. Accessed February 2, 2021. https://www.ama-assn.org/residents-students/transition-practice/physicians-government-fda-and-public-health
Categories
Clinical Lifestyle Patient-Centered Care

Running Low and No Longer Running

I recently completed a rotation in endocrinology, and I learned valuable lessons about diabetes management in both the inpatient and outpatient setting. Today, I wanted to share a clinical pearl generally not discussed in lectures: Diabetic patients often gain weight because of the fear of hypoglycemia.

That’s right. The fear of hypoglycemia drives patients to eat a little more at meals. Let’s backtrack. Patients who have persistently elevated sugars are often started on insulin in addition to oral agents. Depending on their insulin regimen, patients may not eat enough after an insulin dose to prevent a drop in blood sugar. Patients who experience a hypoglycemic event try their best to prevent it from occurring again. This is understandable—fainting is scary and should not be taken lightly (pun intended).

The problem is that patients counteract this fear of hypoglycemia by either eating more after an insulin injection, or by exercising less. This impedes diabetes management. In addition to advising our diabetic patients to monitor their carbohydrate intake, we urge them to start some form of physical activity. Physical activity enhances the body’s insulin sensitivity—it gets to the core of the problem (insulin resistance) and improves overall cardiovascular health as well. But how can we encourage these lifestyle modifications if our patients are getting lightheaded after injections?

The answer: carbohydrate counting and education.

Not the answer: increasing insulin.

My attending explained that “increasing insulin” is actually what happens in some cases. For example, let’s say a patient named Sara comes in for her follow-up appointment and unknown to us, has “fear of hypoglycemia.” Sara brings her glucose meter, and the sugars are poorly controlled. Part of the reason for this poor control is secondary to a) eating more after an injection to prevent fainting and b) decreased physical activity to prevent fainting. Now, if we just treat her numbers, we would increase her insulin.

The lesson here is that one can’t just treat the number in medicine. Talking to the patient, even for a few minutes, will provide the story. Increasing the insulin perpetuates a viscous cycle, and breaking the cycle comes from better regimen management. Validating patient concerns about hypoglycemia and educating them on injecting based on carbohydrate intake is invaluable.

Photo Credit: Melissa Johnson

Categories
Clinical Emotion Empathy Humanistic Psychology Reflection

The Enigma of Empathy

“My mother says I’m a piece of shit.” My 18-year old patient sits at the head of a conference table, her face stony with resolve. The members of her care team are surrounding her. She asks, “Why do you all care about me when I don’t even care about myself? That’s just weird.” Her resolve crumbles and tears begin rolling down her cheeks.

The attending physician stares at her before responding. “We don’t know you,” she says. “But we do care about you. You’re right-it’s a weird concept.”

It took this exchange-during my final year of medical school-for me to fully grasp the unusual nature of the empathy that we have for our patients. As medical students, most of us have described ourselves as empathetic or compassionate at some point. But I’ll wager that most of what we know about empathy comes from close relationships, be they with friends, family members, or even repeat clinic patients. It’s not difficult to understand how these established relationships could be colored with empathy. After all, these are relationships that we usually choose to have, or at least, choose to continue having, and in many cases, they’re relationships of mutual benefit.

As medical students, much of our experience is gained on the inpatient units in the hospital, with patients who are thrust into our service. While it is possible that the relationships we have with those who are closest to us serve as templates for empathy, the relationships that we develop with our hospitalized patients are different in several ways. First, we do not choose these relationships. Generally, patients are assigned to us regardless of our desire to have them as patients. Part of being a physician in training implies consent to treat patients. Another reason why our relationships with patients are unique is that we rarely can choose to terminate a relationship with a patient who we are treating. Finally, the relationship between the hospitalized patient and the doctor is not mutual. Hospitalized patients cannot and should not offer any direct benefits to their treatment team. My relationship to this 18-year old patient fit all the aforementioned parameters: I did not choose her as my patient, I could not stop my service to her, and I enjoyed no direct benefit from her as my patient. And yet, even accepting the above as true, even recognizing that I had only known this person for 48 hours at the time of this discussion, my empathy for her was not any less genuine than my empathy for my best friend or closest family member.

Does being a physician mean that we are forced to have empathy for near-complete strangers? Or does it mean that the people who choose this profession are characterized by an ability to freely give empathy to those who cross our path?

Interestingly, the word “empathy” did not reach the English language until 1909. Derived from the German word “einfuhlung” (or “feeling into”), it has been a continually enigmatic concept that has eluded any simplistic definition. Philosophers have described empathy as a central emotive descriptor that characterizes the feeling one has when they recognize the human spirit in another.[1] Even neuroscientists have taken up the job of trying to define empathy, noting that mirror neurons, which are neurons that fire when one living creature acts and then observes the same action in another living creature, may play a role in the development of empathy.[2]

Reflecting on my patient’s remarks has given me serious cause to contemplate what empathy means to me as a soon-to-be physician. While I can speak only for myself, I think the thing that makes me different is not my capacity to give empathy, but my desire to foster relationships with my patients. Even though my relationship with that patient may have been only days old, the quality of that relationship and therefore my ability to feel empathetic towards her, is a direct reflection of my desire to have that relationship. While I did not choose the patient, I chose to get up that day and practice medicine, and empathetic medicine is the only kind of medicine I know how to practice.

[1] https://plato.stanford.edu/entries/empathy/

[2] https://www.ncbi.nlm.nih.gov/pubmed/18793090

Photo Credit: Sean MacEntee

Categories
Emotion Empathy General Humanistic Psychology Narrative Public Health

Guter Mann

This city is so peaceful. As the bikes whiz by, I notice the absence of the cacophony and polluting fumes of traffic. I’m walking down the sidewalk in brown leather shoes and a tucked-in dress shirt while eating bougie gelato. I love gelato. I look up and notice the blue sky. It’s a deep blue and the clouds have distinct borders. I’m in Salzburg, Austria for a conference and I’m loving this city. Just as I marvel at the clean streets and begrudge the abundance of luxury vehicles, I turn the corner and see my sister on the floor asking for money. I immediately cross the street and reach in my pocket to hand her the change I received at the gelato stand. My sister is donning the flag of Islam on her head and I greet her with the anthem of Islam, a greeting of peace. She smiles and says, “Allah yijzeek al-khayr” – God reward you with the good. As I walk away, I smile at the beauty and seamlessness of our interaction.

I continue walking back to the conference hall. I review my rehearsed words as I finish my gelato. My presentation is on the data I generated regarding the controversial use of bisphosphonate anti-resorptives in the setting of chronic kidney disease mineral bone disorder. The nephrologists in the crowd won’t be too thrilled. In my head, I am considering all the different questions I could be asked, when I see another of my friends on the corner of an intersection. As I approach him, he brings his hands together and bows his head. When he raises his head again, I smile at him. I don’t have any more change so I reach into my pocket and hand him 5 euros. He has a cup in front of him, but I decide to hand him the money. I think this might make the money more of a gift than a charity. I can see hurt in his eyes as he tries to find a way to thank me. Reaching out I put my hand on his shoulder and squeeze, pointing up with my other hand, trying to tell him that I will pray for him. While my hand is on his shoulder, he turns his neck and kisses my hand. I say, “No, no!” and withdraw my hand. I feel ashamed. I know I should be the one kissing his hand for accepting my miserly gift of 5 euros while knowing full-well that I have another 10 laying comfortably in my pocket. Ten euros that I will, over the next couple hours, undoubtedly spend on a sacherwurfel from the bakery next to my fancy hotel and then on another helping of overpriced gelato.

Lost in my thoughts of embarrassment, I begin to walk away, and as I do, he yells in German, “Guter mann!” – good man. Halfway across the street, I think to myself, I may not be a good man, but I have the opportunity to try, and so I turn back around.

Ten euros was all the money that I had left on me. But 10 euros was all it cost to earn the respect and love of a man I had only met minutes ago. Excitedly, the man begins to talk to me in German. His name is Damien. (We spend a good 5 minutes on my name. I would say, ‘Mo-ham-mad’, and he would then repeat after me, ‘No-han-nam’). Damien is a father of 3 kids. He was doing well for his family until his wife lost her vision. He said, “Now my heart is still good, but children’s stomachs are empty, so my hand is outstretched.”

I notice the tears in my eyes. I had never heard German spoken before, and I shouldn’t know what he’s saying to me, but I understood every word. Home is where the heart is, and this man is my neighbor. As I leave Damien for the second time, I point up again and then turn my palms up to the Heavens in prayer. He says, “Allah.” And I repeat, “Allah.”

On my second day in Salzburg, I take the long way to the conference center, hoping to run into my friend Damien. I turn the corner and there he is, sitting at the end of the block. My stride lengthens and my steps quicken. As I approach him, I see him leaning left and right, squinting his eyes; he’s trying to see if it’s me. He leaves his corner and yells, “Nohannam!!” while jogging towards me and we embrace each other as brothers and lifelong friends. And as my neighbor and friend embraces me, I realize I may not be a good man, but Damien is willing to show me how to become one.

Photo Credit: Sam Rodgers

Categories
Emotion Empathy General Humanistic Psychology Narrative Patient-Centered Care Psychology Reflection

Immigrant’s Suitcase: Ordinary people with the will to do extraordinary things

A mother separated from her missing husband flees a war-torn country, her homeland, to provide a brighter future for her children. She’s a dentist by training and practiced dentistry back home; but here, here she’s cleaning homes for a living. Why? When she left her home with her four children by her side, headed to a safer place, to America, what was in her suitcase? Alongside the picture of her missing husband and the few possessions that remained after the destruction of her home, in her suitcase, she has hopes and dreams, fears and doubts. She looks to her children for strength, but she’s terrified every time she looks them in their eyes. She is not optimistic, but she is hopeful; she looks the odds straight in the face and proceeds anyway. Because hope is not logical, it is powerful.

She’s cleaning the home of a happy family; the father is an engineer and the mother is a doctor and the children play piano. Their life, their hopes, goals and dreams are dependent on the stability of their country, but they cannot see it. The same hands that used to place crowns to relieve the pain of the suffering are now scrubbing the floor of another woman’s bathroom. But hope is powerful, and she lives through the dreams of her children. Two of her daughters want to be doctors. Her third daughter wants to be an artist. Her son is eight and he loves math. In her suitcase, she brought with her the dream of a better education for her children. “In Syria, we ate grass. In Egypt, we didn’t have food. In Indiana, I love school.” These are the words of her eight-year-old son.

A man runs to catch the bus. He can’t miss the interview; he really needs this job. It is his third interview in as many days. His last job got him enough money to get his family off the streets for a couple weeks. But motels are more expensive than he ever imagined. He’s homeless. His family is homeless. This wasn’t a possibility he considered when he graduated with his MBA. He had a great job, but the hurricane took everything away. And he hasn’t been able to get back on his feet. He catches the bus and pays the $1.75 in quarters. He checks the email that he printed; the interview is in room 4015. He runs up the stairs; he really hates being late. As he enters his interviewer’s room, a bead of sweat runs down his forehead. What’s in that bead of sweat? Desperation and nervousness, humiliation and self-pity, purpose and resilience.

His interviewer gives him the job offer. He smiles and shakes his head. A tear runs down his face. He can’t take the job; he can’t manage the branch that makes most of its revenue through alcohol sales. Another day and another interview, but his family remains homeless. He needs the job, but rejecting the offer was an easy decision. He believes that although alcohol may have small benefits to people and society, the harm it causes is much larger than its benefits, and wants to play no part in its distribution; he will not be a co-creator in the intoxication of his neighbor’s mind.

A young woman sinks into herself on the examination table. Her husband is holding, squeezing her hand. The doctor is still talking. He looks very sympathetic. The young woman just learned that she has a cancer growing inside of her lungs, an aggressive cancer. The doctor thinks ‘we can fight it.’ The young woman’s mind is overwhelmed into quietness. All she can think about is her daughter’s play after school that she doesn’t want to miss, even for this. The doctor brings her back, ‘Do you feel comfortable about our next step? I think that’s the best place for us to start.’ The young woman shrugs. What is in that shrug? Fear and uncertainty, peace and tranquility, ambivalence, a need for normalcy, a desire for time to make meaning.

The young woman is herself a physician, trained and licensed as a radiologist. She knows enough about cancer and the late stage non-small cell lung cancer she has been diagnosed with to know that the longevity of her future has been called into question. And yet this is not the topic of discussion with the doctor. Instead, he discusses treatment options, which is fancy talk for a long list of big words in different orders and combinations. When asked about the next step, she shrugged. She shrugged because there didn’t seem to be room for her in that room. (Insert young woman with terminal cancer here). Although it is more comfortable for the doctor to rattle off treatment options, the patient wants to take time to acknowledge the inexorability of our life cycle. To the doctor, it was the end of a beginning, and they were, together, supposed to begin a new chapter of strength and resilience. While he rattled off treatment options, she just wanted to catch her daughter’s play after school, and she was running late.

In the words of HL Menken, ‘For every human problem, there is a solution that is simple, neat, and wrong.’  Without taking a moment to explore what’s inside the immigrant’s suitcase, the homeless man’s bead of sweat, the sick young woman’s shrug, we stand a sorry chance to witness, help, and learn from ordinary people with the will to do extraordinary things. This is the power of narratives; the power of listening. I call myself to look inside the suitcase, to investigate the bead of sweat, and to ask about the shrug; I call myself to listen.

I find myself in an imperfect world, full of injustice and oppression. I find myself an imperfect man perfectly given the ability to alleviate suffering, on a personal level with a smile or a hug, and on a larger scale by fighting injustice and refusing to stand idly in the face of oppression. Poverty belongs in a history museum. And hunger…we have enough food in the world for every member of the human family to eat a balanced 3000 calorie meal. When we eliminate poverty and hunger, there will be many other injustices for us to face. I want to make facing these injustices my mission. My mission is to be ‘human’ as best I can; to work to establish justice in any capacity that I can, from a generously given smile to an honest political campaign.

Photo Credit: Robot Brainz

Categories
Empathy Technology

Robots: Not just for kids any more

Years ago, my brother and I shared a metal robot with moveable arms and legs. This plaything belonged to the same fantasy realm as Barbie dolls and Power Rangers, and the idea that it might one day be a colleague was not only unfathomable, it was laughable. Fast-forward two decades to the present day, and robots have a very real role in medical care. At present, hundreds of thousands of surgeries are performed each year using robotic technology[1]. This past June, two Belgian hospitals began employing robotic receptionists that can understand up to twenty languages[2]. In Japan, robots have been used to lift and transfer patients from their hospital beds[3].  And right here in America, Watson, the same robot that won Jeopardy in 2011, is being put through his medical residency in the University of North Carolina Lineberger Comprehensive Cancer Center[4]. Just a few months ago, Watson, who has never experienced the years of grueling drudgery to which we have subjected ourselves as medical students, correctly identified the cancer of a patient whose diagnosis had stumped physicians across the globe[5]. As humankind continues to create technologies with the potential to outsmart their creators, it’s hard not to wonder whether we, as doctors, may soon become obsolete.

While mulling over this very question, I saw a young patient who needed blood work. Upon finding out that she was being sent to the lab, the young girl was filled with sheer terror. After much crying, kicking, and screaming, her mother eventually managed to drag her down to the lab. After we had seen our next patient, the doctor with whom I was working decided to go down to the lab to check on our very petrified young patient. At that moment, I was reminded that our ability to care for people in the most trying times of their lives makes us as doctors unique from most other professionals. As doctors, we will have the privilege of making human connections with each of our patients. Robots can digest huge amounts of information, stay up to date on the most current medical practices, and make correct diagnoses in puzzling patient histories, but they will never eclipse physicians because they do not have a reliable set of ethics, nor do they have the shared human experience that underlies the doctor-patient relationship.

The prospect of artificial intelligence in medical practice may be heralded by some as a major scientific breakthrough, but it is important not to hyperbolize the role of robots on a medical team. Though the prospect of finding forms of artificial intelligence in your local hospital is becoming increasingly likely as time passes, many of us can only speculate what it would be like to work alongside a robotic colleague. No matter what, artificial intelligence should only be viewed as a physician aid, not a physician replacement. While it is true that forms of artificial intelligence may certainly help us with diagnoses and complex surgical procedures, these tasks are only one small part of the care that we as physicians have agreed to provide to our patients. The other part of this care is the genuine concern that we show to our patients. Robots may be more knowledgeable and more hardworking than some human doctors, but until a robot can sense human suffering, walk down to a lab, and hold the hand of a little girl who is scared senseless by the idea of having her blood drawn, they are still incapable of providing the most important medical service of all: empathy.

Featured image:
robot! by Crystal

Categories
Empathy

Properly Unprepared

It was late afternoon, and the current nursing shift would be relieved in less than ninety minutes. The feeling of impending Friday freedom was palpable on the floor of the intensive care unit. I was on my way to meet with my last patient of the week, who had been brought in for an unintentional drug overdose. My goal was to determine whether the overdose was truly accidental, and if she was a candidate for compulsory psychiatric hospitalization. I passed by a large bank of computers without stopping, and knocked on the patient’s door. When I walked in that room, all I knew was the patient’s name, her age, and the reason for her hospitalization. Other than those preliminary facts, she was a complete mystery to me. I spent fifty minutes with the patient, and had a relatively pleasant conversation. When I walked out of her room, I opened her medical chart for the first time.

Unfortunately, that day, the story that I received from the patient and the information that I got from her chart told two different stories. Numerous providers had noted that she was irresponsible with medications, and I got the sense from the chart that she only sought medical care to gain access to controlled substances. Now that I had established a good relationship with my patient, I would have to re-interview her in an attempt to reconcile the information I had seen in her chart with the picture she had painted for me in the moments prior. My Friday freedom would just have to wait.

I would not be surprised to find out that the ICU staff was laughing at me that day. After all, I ended up spending more than two hours with this patient when I could have conducted only one brief interview. Even though the majority of my first hour with the patient was pure confabulation, I viewed it as a valuable component of my assessment. That first hour represented my sole opportunity to get to know my patient without any bias. Had I looked at her chart before walking into the room, I unquestionably would have written her off as an irresponsible, drug-seeking troublemaker. I would have asked her pointed, perhaps accusatory questions about her behaviors, and worse, I would have known exactly when she was lying to me, further eroding any respect I may have had for this patient.

Electronic medical record systems help to facilitate the sequestration of large amounts of information about our patients with minimal effort, and it’s largely considered taboo to meet with patients without first researching their medical record.  The information physicians can learn from the medical record can be undoubtedly beneficial in many situations, but extensive chart reviews can also lure us into a false sense of security, allowing us to preconceive an identity for our patients before ever having met them.

Had I read my patient’s chart that afternoon, I am certain that I would have made judgments about her that would have influenced my interview. Instead, I learned about my patient by allowing her to tell her own story. I thought about the information she shared with me, and, perhaps more importantly, what she failed to tell me. Because the patient never discussed her well-documented mishandling and possible dependence on prescription medications, I felt confident in making an assessment that this patient had relatively poor insight about her problems.

Featured image:
hGraph: patient + clinician looking together by Juhan Sonin

Categories
Emotion Reflection

The Power Of Crying

Last week, we started a class called “Death and Dying” (doesn’t it sound fun?).  Jokes aside, this class is a valuable component of the medical school curriculum. Physicians deal with death on a regular basis—some every day, and others every hour. During one of our discussions about a patient, a small tear rolled down my cheek. I quickly wiped it away in embarrassment, pinched myself to “get my act together,” and hoped no one had seen. Later that day, I wondered what would have happened if another student had seen me almost cry? Would their opinion of me change?

I am a “crier.” Not when I am faced with my own struggles, but when those I love go through happy or sad times, that’s when the waterworks kick in. This has me worried. I know that crying is seen as a sign of weakness. Some would even call it unprofessional, and I can’t blame them. Our profession teaches us to set personal and emotional problems aside. But what happens when our profession is the cause of these emotions?

A recent discussion we had in class answered my questions. It turns out that crying is okay. Of course, this does not mean we should break down every time a patient has to spend an extra day in the ED, but it does mean we can be vulnerable in a highly professional setting. One of the pediatric oncologists shared a special patient experience with us. She had always shied away from crying in front of her patients. However, one day after a family had received especially disheartening news, she unintentionally teared up in the clinic room. This was well received by the patient’s family—the patient’s mother told her, “It let me know you cared.” From that point on, the physician’s relationship with the family was altered—an unbreakable, unspeakable bond was formed.

This alleviated a few of my fears concerning the display of raw emotion. We are in a profession where humans care for other humans. It is natural to cry. In fact, we become physicians because we deeply care and love others. Showing this empathy is not a sign of weakness—it is a sign of power.

Yet, there are some important points to remember about crying. Though releasing a few tears is okay, you cannot become a mascara-stained mess.

  1. Your tears have to come naturally. These tears are symbols of your love and devotion. They signify your raw, genuine emotion. Don’t cry to make yourself closer to a family.
  2. You still need to be strong for your patients and their families. You want to be able to process and deliver information to them in a calm, collected way.
  3. You do not want to cry and then have your patients feel they have to comfort you. You are their robust pillar of support! They should be leaning on you for guidance and comfort—not the other way around.
All in all, I am happy to have realized that watery eyes in the clinic will not make me a pariah. Crying, like all aspects of medicine, has to be motivated by your candid empathy. Only then can it be powerful.
Featured image:
A Single Tear by Lauren C
Categories
General Reflection

Can Empathy Be Taught?

As medical students, we are taught to examine patients, recognize symptoms, and treat diagnoses. We get lost in the sea of differential diagnoses and worries of exams. I always worried that I’ll never remember all the important facts, that I’ll miss an important sign or symptom or forget an essential part of treatment in an emergency situation. When I faced my real-life patients, I realized that I was indeed not ready. Surprisingly though, it wasn’t the lack of theoretical or practical knowledge that worried me anymore, but the fact that each patient required a different approach. Some patients are serious and to the point, others are full of witty remarks about not only their condition, but all sorts of topics. Some don’t want to know much about what’s happening to them, while others have countless questions. Their behavior might be a part of their usual personality, or it could be changed because they have found themselves in a new, often scary situation. I wanted to, had to, understand why each of my patients acted and thought the way they did, so that I could adapt my manner, make them more comfortable, find out more information, and finally, earn their trust.

In observing my seniors, doctors with years or decades of experience, I have noticed their style of communication with patients comes from every part of the spectrum. Some are empathetic and communicative, dedicating a large portion of their time to their patients; others are introverted, avoid communication with patients at all costs, or can even be patronizing and show little understanding.

In the past, medical education focused primarily on academic knowledge and practical skills. Today, however, the importance of doctors’ communication skills has obviously been recognized and integrated in our education. But can empathy be taught?

We can learn to shake a patient’s hand, to ask for permission before examining them, to perform other small actions that take little effort but make our patients much more comfortable. In order to better understand our patients, to get them to open up more easily and reveal parts of their medical history they would otherwise conceal, to treat them in the most individual manner possible, we need to empathize with them. I’ve seen my colleagues to whom this comes naturally, but I’ve also seen others whose attempts at empathy take a lot of effort and energy.

Because I am at the very beginning of my medical career, I realize my point of view might be naive. Still, at this point I believe I should focus on each patient. I should empathize and understand each individual fully before attempting to tend to his or her troubles, however much energy that takes. I am also worried about the possibility that this ability can be lost. I often wonder if the more reserved senior doctors have always been that way, or if their energy and will to empathize have been lost after seeing innumerable patients.

I don’t know if empathy can be taught in classes, but I do believe everyone can develop it. Unfortunately, I think the ability to empathize can also be lost. Ultimately, this social dimension of medicine remains different for each health professional, and their ability or will to empathize remains their choice, depending on how they choose to integrate their theoretical knowledge and experience with their personality.

Featured image:
empathy by Sean MacEntee