The unspoken assumption that doctors are well

We heard from a patient during our dermatology week, who worked as a medical laboratory technician, running hundreds of blood samples every day, and frequently using her own blood as the negative control. Then she began to notice that the numbers stopped making sense. Her ANA had shot through the roof and her white blood cells started dropping.

“I couldn’t use my blood as the negative control anymore,” she said, shrugging slightly.

Her stoic face didn’t reveal much, but I imagine that being dethroned from the pristine world of negative controls into the confusing milieu of mucked up numbers and unsteady ground couldn’t have been an easy thing to accept.

She had lupus.

A few more things followed. A friend confessed to me that she didn’t particularly appreciate the accepted, if not expected, gallows humor that our classmates used in talking about diseases and disease states. Sure we all knew that we were teetering on the edge of propriety when we tried to remember the functions of the different cranial nerves by acting out their deficits, but there were good reasons. There were always good reasons. We were coping with the vulnerability of the body, the darkness of the world we encountered daily; we were only using humorous study techniques to process the huge quantities of information thrown at us; we were just being kids. We were joking. No harm, no foul.

But the friend protested the unspoken assumption that as medical students, as those on the other side of the patient-doctor relationship, we were well. Not many of us have cruised through life without ever having visited the realm of the ill, or perhaps seen a close family member or friend acquire such a passport.

One of my classmates in fact recently published a piece in JAMA’s A Piece of My Mind illustrating her experiences of going through medical school against the backdrop of cancer. Shekinah wrote about how medical students, like physicians, are imagined to be among the well. Professors reinforce this, calling us healthy for being young and presenting without “clinical findings.”

“The mechanisms for heartbreak and loss are not on the docket of our formal education,” she wrote.

It’s not an easy balance to manage. Physicians don’t like to count themselves among their patients, despite the fact that they very well may be some other doctor’s patients. We value this dichotomy, this breathing space, this space to joke and fool around and talk about diseases and being ill without feeling vulnerable or sad. With the model of thinking that we’re all in this together, that any of us can be implicated, we lose that. There’s the idea that treating illness as something too sacred to tease would force us all to be politically correct at all times. That too much respect would lead to fear, and so on.

But I think that no one really requires either extreme. Acknowledgement can coexist with detachment, empathy with intellectual curiosity.

To illustrate, another classmate recently told me that in her psychiatry small group, the physician prefaced a discussion of schizophrenia with a nod to the idea that no one in the group suffered from such a burden to the mind.

That. There’s the danger. That’s the logical leap in question. None of us are spared, now or later. To forget that is just not fair.

Samyukta Mullangi is a medical student who writes at her blog, Samyukta Mullangi.

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  • http://angryfemur.tumblr.com Andrea Lane

    This is a very interesting article, probably because it is so at odds with my view of many medical students.

    Most of my friends from high school are now in medical school. When I still lived in my hometown, I would frequently go out with them and their friends, and I was intrigued by what I found.

    Med students are crazy.

    They binge drink, they eat garbage, they exercise infrequently. In short, they are normal 20-somethings. While they are ‘healthy’ insofar as they mostly have no serious chronic or acute conditions, their lifestyles are stressful and do not promote a great deal of wellness.

    I’m currently enrolled in a program to get my masters in acupuncture and Oriental medicine. The difference between my classmates and the western medical students I’ve seen is quite fascinating: many came to the field because they had been chronic sufferers of digestive conditions, women’s health issues, etc. They have spent a lot of time learning about diet and nutrition, about exercise and the body. I would say, overall, that they LIVE healthier, even if they aren’t originally well.

    This perspective, I feel, gives these students a great deal of insight into how it feels not to be well. As a result, often their mannerisms are much more reassuring and understanding than many doctors I’ve seen.

    My point is that medical students shouldn’t be afraid of being sick or suffering from a chronic condition because it undermines their practice. In fact, it can often give one an astounding perspective on how the mind adapts to the body’s difficulties. It is not a hindrance, or anything to be ashamed of, but should be instead transformed into a source of strength. 

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