Thursday, March 10, 2016

Chicken soup for the doctor's soul

Courtesy of my very dear friend, Nurse Practitioner Megan Crawford, comes a link to a medical student's essay on the lost opportunity of "professional distance".

Breaking Boundaries and Finding Love in Patient Care

It's a great story by a fourth-year medical student, discussing her admiration of a preceptor who's unafraid to show deep commitment and affection for a patient. The author herself then lets her guard down with a few patients, and finds that it's very rewarding.

Not even I'm cynical enough to rain on this parade, but there are a few counter-points worth throwing in.

First, I'll be curious to see if the author can still feel the same way after residency. Unfortunately, while medicine is moving (or is professing to move) into patient-centered care, we still train doctors in overstuffed hospitals under grueling conditions. Combine that with punishing student debt and a near-total absence of a personal life, it's a miracle that doctors come out of training with a shred of compassion left.

Second, it's easy to forget that a patient, even one you've known for a long time, is very much still a stranger. Someone I've seen five or six times a year for three years has yet to spend the equivalent of a dinner date in my company, and most of the conversations still center on medical concerns.

It's not that I'm advocating being cold and aloof. Learn what you can about the patient's personal history and hobbies, share a laugh, talk politics (avoid religion, or prepare to be proselytized to). But it's vital to recognize the sometimes-hazy line between engaging with a patient and becoming a part of one another's "lives". You never know when you can take the same license to speak bluntly with a patient that you can with a friend. Moreover, getting too involved in your patients' lives can lead you to take on their problems without the opposite being true (really, you can't dump your problems on your patients). As I'm sure anyone in health care can attest, "bringing it home with you" almost never ends well.


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