“This can be a depressing specialty at times; we laugh to stay sane,” my attending explained as I stared in dismay at the cackling residents and faculty after one of them made a rude comment about their patient. This was the first day of my rotation on this service and I was very disappointed. Still brimming with the ideals of professionalism taught in the first two years of medical school, the scenario I witnessed seemed unreal—how was it that residents and faculty were so casually discussing a patient in derogatory terms and laughing? What happened to respecting the patient and this whole idea of the fiduciary relationship? Does respect cease to exist in the absence of the patient? What was going on?
With all these questions running through my head, I sat there, slightly frightened of what the scenario I just witnessed could mean for me. These people were going to become my colleagues in less than two years. Would fatigue, stress and an endless patient list turn me into a cynic, too?
As the days went on, I realized that I became accustomed to their way of maintaining sanity and even found myself laughing at the jokes. My laughter gradually became cynical thoughts about patients. I started to doubt their stories, question their motives and sometimes lack empathy for their pain. What was happening to me? I had only spent a few weeks on the rotation, and I was already cynical. After analyzing my actions, I realized that I was influenced by two things.
First, the people I was working with influenced me. I am not one to pardon ill behavior because of peer pressure. However, I must say, that those around you can have a significant effect on your actions. As a new third-year who was (and still is) trying to navigate her way through the system and figure out “how things work,” it is easy to pick up the habits of those who are in positions superior to yours—consciously and unconsciously.
Second, I was influenced by my determination not to be duped by a patient. I wanted to be an astute clinician who could easily decipher a malingering patient from a genuine one. Most students would ask, “What is wrong with that? I want to be that type of clinician, too.” There are a couple of problems with that statement. One, to become an “astute clinician” requires a lot of experience, something I am still working on as a third-year medical student. Further, the word “easily” cannot describe the act of figuring out when a patient is lying because physicians are not mind-readers. There is nothing wrong with wanting to be able to detect the truth. The problem for me is that I tend to be gullible. I generally take people at their word and trust that they are telling me the truth. I have found that this quality sometimes leaves me vulnerable for manipulation. I did not want to be manipulated; I did not want my patients to use my empathy against me.
The above were genuine excuses for why I was becoming a cynic, but they were just that: excuses. In order to live up to my ideals, I needed to figure out how to change my mindset. Fortunately, I was able to discuss my observations with my classmates, and the discussions reminded me that I am not alone on this journey. I think we can all benefit and avoid becoming jaded if we remember that there are other people facing our same challenges. We have classmates and faculty who are cheering us along. Having the support of others can make it easier to keep doing the right thing.
As a third-year, I do not have all (or even most) of the answers to the dilemmas or conflicts that will present themselves. Yet, I know that in order to grow into the type of clinician and person I want to be, I must be brave enough to reflect on my behaviors, thoughts and motives on a regular basis. I must learn to take responsibility for my actions. The understanding that I am human and flawed is humbling, liberating and a little scary, especially as a doctor-in-training. Yet, I believe it is this understanding that will keep me grounded, help me maintain that fiduciary relationship with my patients and avoid cynicism. It is vital for me to remember that no man or woman is an island and thatdiscussing concerns with trustworthy colleagues who have the same vision can be very helpful. The realization that there are others who desire to live up to the same ideals I have provides strength and encouragement to keep moving in the right direction.
So, next time I hear a rude remark about a patient intended for comic relief or listen to a patient tell their story about their pain, I have a serious decision to make—to be cynical or not to be cynical, that is the question. In that moment, I really hope I make the right decision.