Saturday, September 20, 2008

Down the Yellow Brick Road

When I went to my Western interview, one of the physicians gave a talk about the "yellow brick road" of medical education. It was a cheesy little talk about how medical students enter school, like Dorothy's companions, seeking intelligence (scarecrow), compassion (tin man), and courage (lion). In the process of education, we often acquire intelligence but the compassion and courage are bred out of us. The doctor went on to talk about how at Western, they make sure that their students retain their compassion and courage. Years later, Western grads who have gone on to become residents at other schools like UofT call them up with complaints like, "I almost had a losing 'heart and courage' moment. Can we talk about it?"

At the time, I thought it was the corniest thing I had ever heard. However, as cheesily as he had phrased it, the principle of the talk was true. In the first two sessions of clinical medicine course, the physician tutors talked at length about how important it is to address the patient's needs and the patient's agenda. Often doctors have their own agenda, and seek to fulfill their information-gathering needs without regard for the patient. This can lead to miscommunication and dissatisfaction on the patient's part. Meeting the patient's needs is also important, and thus the needs of the physician and patient must be balanced. It is important that the patient feels like they are being listened to and that their concerns are being attended to, and in doing so, the physician also often elicits important information that they might have otherwise missed.

Today, I took part in an observership at a local area hospital. As it sounds, I got to observe real doctors putting real medicine into practice. All of them were nice people, who joked around and were well-liked by the staff. All of them were excellent physicians, with vast medical knowledge that they used to make diagnoses and plan medical treatment. However, what really surprised me was the brisk nature with which some of them treated patients. While they were excellent at treating the illness, I could often see where miscommunication might be starting to play in. In addition, while the patients' medial illnesses were being treated, I felt like not all their needs were being met. For instance, one patient was expressing a great deal of pain due to their condition, but the physician seemed relatively unresponsive to this while conducting the necessary physical examinations. Then once he was done examining, he quickly slipped out of the room.

In retrospect, it is actually foolish of me to be surprised about this. After all, when my physician tutors talked about how important it is to attend to the patient's needs, they cited troubling statistics about how many physicians do not. Similarly, they explained that many medical residents forget these kinds of basics because they accumulate so much knowledge that they become simply focused on the problem and the application of that knowledge. Yet here, at the beginning, I can see how some of these situations might have been significantly better for the patient had the doctor done something as simple as acknowledge their pain, and talk soothingly instead of responding in a detached, apathetic manner (treating the patient as a person rather than a problem to be solved)... this wouldn't necessarily have taken more time. Clearly, this is something not lost at least to the physicians who teach first-year students.

Yet looking towards the future of our education, as we accumulate knowledge and seek to solve problems, am I too destined to treat people in pain in a detatched, analytical manner? And so, I must admit, as corny as it sounded the first time, maybe it really is important to be guarding our "heart" and our "courage" as we go along.

1 comment:

sandlot said...

You know, if you came to Western for med, you could be in my room right now studying with me...