Ever since I first thought
about applying to medical school, I've held strong beliefs about what a physician should
and shouldn't be. (I think at the beginning, I had a lot more shouldn=ts than shoulds!) I
didn't like waiting in a waiting room for hours. What this has always said to me is that
doctors believe that your time is not as valuable as theirs. I also didn't like going to
doctors who asked a few questions, examined you, gave you a prescription and shooed you
out the door without explaining what was wrong and what they were giving you. How can
people be responsible for their health if they aren't informed?
While I knew what I didn't want to be, discovering what I did want was more difficult -- criticizing is much easier than being constructive. I knew that I wanted to be sensitive to people's needs and to respect them as equals. I also wanted to focus on prevention and education rather than spending all my time concentrating on disease.
When I started medical school, I found Clinical Skills to be self-affirming. We learned how to connect with others and create a rapport with people. The focus changed in Clinical Skills during Integrated Study of Disease when we started seeing real patients. We were learning how to perform histories and physicals -- the basis of "real" medicine. As for exploring the opinions and emotions of others -- "touchy-feely stuff" -- my training indicates not that I should respond and make some connection, but that I should use them to assess the validity of the patient's statements or else disregard them as impediments to getting the facts I need.
Medicine is a science, and as such, its focus has traditionally been on the tangible aspects of human beings, that which you can see, touch and document. Emotions and social problems are messy and difficult to deal with. They require a great deal of time and offer little reward. It's no wonder that doctors prefer to stick to the relatively simple workings of the human body.
Many people are frustrated with this perspective, however. Often, what they want is just a few words to help them understand their condition, to help ease their apprehension. In this situation, doctors possess the knowledge and therefore the power. It is their responsibility to communicate this knowledge and do it on a level that patients can understand.
I=m hoping that medicine is changing. In Clinical Skills, we do have the opportunity to view how clinicians treat patients and can emulate those who do it well. With other, less empathetic clinicians (who I truly believe are few and far between), I try to keep in mind what they do so that I won't do the same in the future.
My biggest fear is that I might lose my sensitivity towards others. There have been times when I've been examining a patient and I haven't been as aware of him or her as I would have liked. I expect, however, that as we gain more experience with examination techniques, we will be able to concentrate more on the art of being good doctors: having a good scientific background, but also remembering people's rights to be informed and to make their own decisions, to show them respect.
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