The culture of medicine needs to change

I’ve been involved in clinical medicine for more than 20 years and during this time I’ve come across numerous situations that created stress, or emotional upheaval within myself, and even times of burnout.  At one point, I came close to permanently leaving my chosen profession.  The culture of medicine is not geared towards allowing health care providers to de-stress, acquire emotional support, or discuss in an encouraging environment various conflictive work scenarios with their colleagues. The end result of this culture of medicine leads providers to either leave their chosen profession, have professional burnout, deal with work conflict and/or become emotionally broken (i.e. having a lack of integrity, honesty, emotional connectedness with others, etc.)

An example of medicine’s culture which needs to be changed and causes conflict is one of its many unwritten rules of professional conduct.  It states that the hospital attending is the only one who is supposed to go in and tell a patient their medical diagnosis and treatment.  Anyone else on the medical team is just supposed to pretend as though they don’t know anything until after the attending has discussed the diagnosis with the patient.  Usually this works out, but it can also lead to a breakdown in patient’s trusting their providers and/or asking team members to lie to patients until the attending has this discussion.  This can lead to dishonesty and a lack of integrity on the part of the providers.

I was involved in such a scenario many years ago when I was taking care of a patient on a bone marrow transplant unit.  After waiting several hours for the attending to show up to talk to the patient, and he was still no where to be found, the patient asked me a point blank question that I couldn’t ignore.  My choice was to tell her the truth, or to lie.  I chose to tell her the truth and hold onto my integrity.  Had I followed the unwritten professional code of conduct I would have ended up having to lie, and the end result would have been the patient questioning whether she could trust me in any future encounters.

Another example of medicine’s erroneous culture has been the physician never admitting to a patient they made a mistake, for up until recently this had been totally taboo.  It wasn’t until the study came out of the University of Michigan Medical School showing that if the physician sat down and admitted to the patient their mistake, that it lead to a lower amount of malpractice monies, which lead to this cultural taboo finally being broken.  A positive side to this though, was it allowed the physician to be real and honest instead of deceitful with the patient.  These kinds of interactions can lead to healing of a broken relationship, instead of continual conflict and unhappiness.

Another cultural expectation of medicine is that providers don’t talk about our lack of knowing everything in every situation.  We don’t admit our humanness, our capability of making a mistake.  We don’t want to seem weak in front of our peers.  So we isolate ourselves, and this is never more evident than when we feel we have made a mistake.  Instead of getting the necessary support from our colleagues, we keep quiet and go about our business as though nothing has happened.  By doing so, we are shutting down emotionally and not allowing healing to take place.

The culture of medicine needs to change.  Thankfully it has begun to do so.  Much of this change is due to a patient, Kenneth Schwartz, an attorney who lived in Boston.  He died in 1995 from lung cancer.  His legacy was to leave a portion of his estate to the Schwartz Center for Compassionate Healthcare.  With the backing of this center, currently at over 240 healthcare facilities (and growing) there is now what is called, Schwartz Rounds.

Schwartz Rounds are held every two to four weeks.  All health care providers may attend these meetings.  They are geared to offer emotional support, encouragement, healing, connection with your colleagues and possible answers on how to be an emotionally whole clinician.   Hopefully through Schwartz Rounds and other endeavors which will crop up like it, professionally trained health care providers will find a way to address their emotional stress, feelings of isolation, and burnout.  We all have a place at the table, it’s time we let our fellow colleagues know of our support for them.

Sharon Bahrych is a physician assistant who blogs at A PA View on Medicine.

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  • Gregory A. Buford

    Great article.  I couldn’t agree more.

    On a positive note, I have seen some change in the last few years with respect to a more open approach to our patients regarding our vulnerability as human beings.  In the past, physicians were effectively treated as super-humans and to fail was to go against an image that was seemingly cast in stone.  Now, more and more practitioners are realizing that a candid discussion with their patients about what they can and cannot do for them in addition to more of a willingness to reveal when things don’t go as planned can be extremely effective in building and strengthening the patient-physician bond. 

    Nice work!

    • Anonymous

      thank you for your kind comments. 

  • Anonymous

    Thank you for posting this.

    I completely agree that everyone in medicine needs to learn to be more honest and open about everything. That includes being open about our hardships and fallibility.

    I am a third year medical student on my psych rotation. Just 3 weeks ago I saw a doctor who I had worked with earlier in the semester be admitted to our inpatient unit for suicidal ideation. When I saw him and he started up a conversation with me, I felt like I connected with him much more than when I worked with him. He was open, honest and took off his mask he had worn for so long. When people become broken is often when they become the most honest. We, as physicians, PAs, nurses etc… need to learn how to become honest with ourselves and our patients before we hit the bottom.

    • Anonymous

      thank you medstudent in regards to your comments above.  Changing the culture of medicine is an issue that every provider has had to face in their practicing medicine.  It affects all of us, and for your professor who tried to end it all he is now facing another aspect of the culture of medicine, i.e. his need to be honest and emotionally connected with his colleagues and patients.  I hope you’re able to help him see the way out of his darkness. 

  • Anonymous

    Nurses are frequently in this kind of a “no man’s land” when the patient/family is asking questions that we know the answers to, but the physician hasn’t had a chance to “officially” explain yet. It’s a delicate dance we do to answer questions, but not answer THAT question. 

  • Nina Stolpe-Elnaes

    It is time for more honesty….

  • PamelaWibleMD

    It’s time for less professional distance & more vulnerability. For me, I threw out my white coat and I sit beside patients in a wicker chair at eye level. I laugh, cry, and joke around with them. I’ve actually healed patients who came in with pain and left well just by “being” with them. Healing is bilateral in these encounters. We have to be open to receiving, not just giving. 

    Many doctors are holding support groups for each other around the country. This winter I’m hosting free retreats for physicians at a beautiful hot springs resort in Oregon. It’s up to us to heal the wounded healers among us other – before we are admitted to the psych ward.

    Peace ~

    Pamela Wible MD

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