When I told people I was going to medical school, the first thing I’d hear was, “Oh, you’ll be a good doctor.” As an idealistic and energetic first-year, I was flattered every time a standardized patient complimented me. But I wasn’t a good doctor — I don’t even have an MD. I was exposed to esoteric subjects like biochemistry and physiology, but I wasn’t much help to any person in distress. I believed, like my classmates, that I would be a great doctor, but I knew that I lacked clinical knowledge, acumen and experience.
As a second-year medical student with most of my classroom experiences behind me, I’ve begun to develop that acumen and knowledge. I’m still lacking in detail; I often mistake “horses for zebras,” as they say. I made a diagnosis of possible Ebola virus in a patient with bloody diarrhea, but it turned out to be Salmonella from bad chicken. I hope that once I’ve studied First Aid and learnt the theory of medicine, I’ll be a good physician. The question remains: who or what is a good physician?
Naïve and new to medicine, I believed a good doctor is someone who not only knows the medicine and the art of diagnosis, but also cares deeply for and invests in each patient’s prognosis and care. A good physician puts his or her all into a patient. If the patient doesn’t make it, a good doctor feels sadness at his or her loss, but gets up and does it all over again, a dozen times a day. And at the end of the day, they go home to see their loving, caring families and be well adjusted parents and spouses.
However, I’ve come to believe that the image in my mind of a good doctor is flawed. If I’m too invested in my patients, then I increase the pressure placed on me. I risk succumbing to alcoholism, or abusing drugs misbegotten from my own prescription pad in order to forget the people I couldn’t save and the mistakes I made. If I spiral down that path, then I’ll likely cause damage to family, friends and perhaps even patients.
The other path, which many doctors take, is detachment. I can choose to look at my patients like bags of organs with a dysfunction that I can repair or replace. If something fails — if they don’t make it — I can insulate myself enough not to be truly hurt. I can protect myself from self-destruction, and perhaps even accrue wealth, prestige and power. The downside: I wouldn’t be practicing medicine for the reason with which I went into it. I’d be functioning as an automaton and a machine, which should be anathema to a physician.
If I were to be a truly good doctor, I’d have to be like Goldilocks. Just right. I can’t be a callous, uncaring person who sees patients as bags of enzymes and organs. Nor can I be so completely invested in every patient who sits in my exam room that I become haunted by my own failures. I need to be able to care about my work and for the people who need me, but I also need to be able to let go. I need to separate home from work. I need let go of each day’s travails and sleep without worry. I also need to let my failures inform me, and to let them teach me as a physician and human being.
That’s a nearly impossible standard, and we don’t talk about it as professionals. We don’t discuss how to let go. We don’t discuss how, as Rudyard Kipling’s says, to allow “all men [to] count with you, but none too much.” We are taught everything about medicine, but not to express and deal with our feelings. We keep them bottled up inside, unexamined, somewhere deep in our psyche. Expressing our doubts, our feelings, and our weaknesses is frowned upon, or seen as touchy-feely and weak. We repress our feelings and our demons, exorcising them if we must with alcohol and drugs.
Good physicians? I’ve seen some of those. I’ve seen physicians who can stand in front of a crowd of medical students and talk about what gives them strength, what keeps them going, their challenges, the pain they’ve felt, and how they deal with everything. A doctor who works in the trenches of the emergency room spoke about how every day he sees people who are terrified, afraid, and having the worst day of their lives. He said that his job is to make their worst day a little bit better and a little bit more bearable. He spoke about the cost and the difficulty of separating work from home. He spoke about the losses and failures that haunted him. He also said that every day when he walked into his house and saw his daughter’s eyes, his demons were banished.
The practice of medicine is a truly human profession. It is flawed, challenging, inspiring and infused with the sadness of mortality and the fear of futility. To practice that art well may be one of the toughest things in the world. But if my mentor’s words are true, then that challenge may also end up being the most fulfilling thing in my life. I’m not a good physician yet, and not just because I’ve not received my MD. I’m still learning, and still finding my humanity. That’s a process. It’s a long road I will walk every day of my professional career. I gladly start my search for the perfect temperature porridge: warm enough to be compassionate, but cool enough to remain objective. Bon appétit.
The Fourth-Year Faux-cisian deals with the trenches of medicine, the dirty details and the inglorious scut, as well as with the sublime and transcendent moments. The posts I write are about medicine, humanism, life, philosophy, and most of all the ruminations of a young doctor-to-be as he embarks upon the transformative journey of becoming a physician while attempting to hold onto his humanity.