Medicine involves a tension between isolation and connection

I was skeptical when a doctor casually mentioned that 2% of all pregnancies are ectopic pregnancies (in which the fertilized egg is implanted somewhere other than the uterus, usually the fallopian tube). Without treatment, a common outcome is fallopian tube rupture, which jeopardizes the life of the mother. It is a serious medical concern. I shot a confused look at a fellow first-year medical student. Two percent? It seemed way too high.

I checked the literature, and the doctor was indeed correct. Indeed, 2% of pregnancies are ectopic pregnancies, and ectopic pregnancies constitute 6% of pregnancy-related deaths. Why was I never aware of this? Many women I have encountered in my life have undoubtedly had ectopic pregnancies, but no one speaks of it. Illness lurks in people’s lives much more than they make apparent, and my medical training is making me acutely aware of that discrepancy.

In the past few weeks, I’ve become increasingly aware that my medical training and white coat constitute a sort of “all-access pass.” Recently I was passing through our hospital’s ER on a personal errand. Upon seeing my white coat and badge, the rather aloof security guards smiled and simply waved me through the entrance to the medical bay.

In the ER, I spotted a med student I knew who happened to be rotating there. She and a resident were about to examine a patient, and on a whim I joined them. Saying little, I listened to the patient describe deeply private aspects of his life: his methamphetamine use and drinking habits, his family problems, his history of mental illness, and his hopes for the future. I watched as the medical team debated the patient’s diagnosis and treatment. And after about half an hour, I went on my way. A year ago, I would have been stopped at the entrance to the ER; now, no one questioned why I was there. I am part of the club. It feels so strange.

Practicing medicine involves a tension between isolation and connection. On the one hand, I am quite estranged from people. I have so little free time that when I interact with someone, they are usually either my patient, my family, or someone in the health-care field. And yet I learn about and am witness to the most intimate aspects of random people’s lives. Learning medicine is a lonely pursuit, but by accompanying people as they grapple with illness, will I become more connected to my fellow man?

So far, the answer is no. Medical school has transformed how I view people and interact with them. When I am at a party and see someone with an abnormal gait or a cold sore, I automatically start reasoning through a differential diagnosis. When I chat with my seatmate on a plane, I find the need to whitewash what I encounter in the hospital, because people understandably prefer not to hear about illness and death more than they have to. Doctor and patient do not behave as equals, and even though I am not yet a doctor, and even though the people I encounter are not my patients, I can’t entirely ignore this feeling of detachment, of otherness.

“Reflex Hammer” is a medical student who blogs at The Reflex Hammer.

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  • Peter Elias

    “…I can’t entirely ignore this feeling of detachment, of otherness.”

    Yes, expertise leads to asymmetry in relationships. But there is a wonderful symmetry to the asymmetry. While you develop your knowledge of health and disease, you will also come to realize that the patient has spent years or decades becoming an expert in their own lives. This is an expertise you can no more acquire in a 60 minute interview than the patient can become expert in the differential diagnosis or treatment of their migraine during that visit. 

    The detachment allows you to objectively marshall the relevant information. You will need attachment (with listening, empathy, collegiality, power sharing) to integrate your expertise with the patient’s expertise.

    Never forget that the patient feels just as detached (alienated) from our medical universe as we do from our patients. 

    “…by accompanying people as they grapple with illness, will I become more connected to my fellow man?”

    No, but you will have many opportunities to make deep connections to individuals, connections that can be simultaneously painful and rewarding. Seize the opportunities when they present. Enjoy the journey.

  • rs986

    Very nice piece and I like your blog, too.  Wish they’d had blogs when I was in med school!  My only suggestion (and doctors are always full of unsolicited advice, it’s an occupational hazard) is that you go out and do “normal” things — join a softball team, sing in a choir, coach normal little boys in soccer — during your immersed med school years.  Anything you can do to stay in touch with “the real world” of people who aren’t a) sick or b) health care providers will enrich your life, your perspective and your writing.

    I’ve subbed to your blog.  Thanks much and god luck, as Peter says, the journey!

  • http://twitter.com/brookmanknight Karen Price

    Good self reflection.  And I think Reflex Hammer you are at the stage of exhaustion and knowledge which hasnt yet been honed on perspective.  Compartmentalising your life at home and at work is a good thing but dont lose your humanity in either domain.  I believe that is a Doctors greatest strength, to reach through a patients distress and connect whilst maintaining your role as a professional guide.  The ever important boundaries.  Thats why its good to have your own Dr, who doesnt know you as a colleague and dont let your friends/family make you their Dr. Just keep it real. As you move through your training eventually you will get to a place which sees you doing much more than medicine which is what you MUST do as a student and training Dr.  At risk of harping on, your work is not who you are.  Good luck.

  • buzzkillersmith

    Of course medicine is isolating.  You are going to learn that a large percentage of pregnancies have chromosomal abnormalities and are miscarriages, humans unborn to die. You are going to see children suffer and die for no apparent reason. And guess what?  It used to be a lot worse.  Go to a nineteenth century graveyard and look at the gravestones of 5 year-olds.  That’ll kill your buzz.
    You are a soldier in the war on disease, one of the great scourges of your species. It’s what you signed up for, even if maybe you didn’t know it at the time. If you had wanted to be one of the huddled villagers, you wouldn’t have gone to medical school. Maybe you’d be selling insurance or something.
    And it could be even worse than selling insurance.  You could be a 19 year-old buthedontknowchild with a bad brain from an Afghan roadside bomb or just a regular American unlucky enough to have been born to idiot parents. You’re one of the lucky ones, privileged really.
    That said, med school and residency are rough. But they end, and then you can hang out with regular people, have a beer, watch some baseball.  But you’ll always be different….

  • 2013medstudent

    Make time for the people in your life. Go to all the important events and even the unimportant ones. As med students, we feel like we have to suffer to become good physicians. But we dont! You will still do fine if you take the weekend off (except before tests, of course). Trust me, you will never regret not studying, but you will regret missing your friend’s wedding, missing a family member’s graduation and losing touch with all your old friends.

    Medicine can be viewed as a calling or a job. I originally felt that it was my calling, however as I go through third year I feel that viewing it as a job that I love will be better for my long term health. There are so many doctors in practice that are burnt out, disillusioned and just generally dissapointed with their lives. That has been the huge dissapointment of third year. I love the work and I love how medicine helps people, but I hate working with a doctor who is obviously depressed or burnt out. I feel that it is better for me to come to the realization now that practicing medicine won’t complete my life and can’t be the single thing that provides me happiness in my life. Once I got over the initial shock of taking the MD off the pedestal,  I have definitely been much happier with my life.

  • PMD1234

    This is very keen observation- the balance is so difficult.
     Agree with “don’t take on friends as patients”. It never works.
    Definitely keep contact with old friends, and especially those outside of medicine!

  • Sophie Zhou

    When you see a patient, there has to be a distance. He cannot be your friend. How heart wrenching would it be to be faced with the life and death matters of your friend every moment of your waking day? Space is certainly necessary. 

    - alittlehappi.blogspot.com

  • http://www.gretchencampbellmd.tumblr.com/ Gretchen H. Campbell, MD

    I agree with Karen.  Time and experience will give you perspective.  Right now you are in the throws of the most difficult time in a doctor’s life. You’re working your butt off, but you really don’t know much about practicing medicine yet. It’s the strange dynamic of knowing you’re very intelligent but realizing that you really don’t know very much. Medicine is a very jealous career. 
    That said, speaking from the experience of someone who has been in practice since 2003, it does get better. Once you pass all the requisite boards and try to get on with life as a doctor you have to remember to be INTENTIONAL about avoiding isolation.  I host a doctors meeting once a month where I intentionally bring speakers on non-medical topics such as estate planning, etc. This allows for all of us to be more socially interactive with each other.  I am also very active in my community and write for a regional health magazine.
    Be intentional about finding time to diversify your life, or you will run the risk of the anxiety and depressive disorders to which many of us fall prey. 

  • http://profiles.google.com/whereizben Ben Ware

    I’m sorry to hear that you feel like you have so little time to see anyone else – learn now to change this so that you can continue to have a life (I speak as a current third year medical student who is also a non-traditional student) – if you think that in the future things will magically get better you might get lucky, but chances are you’ll just find yourself to be too busy. I’ll admit that I certainly did not get top scores on Step 1 or honor all (or most!) of my classes in the first two years, but I maintained a good life, with plenty of contact with people outside the medical field, and I think I’m a better person for it – I also don’t find myself doing exactly what you describe with generating a ddx, which allows me to truly take time away for myself, and in the end I think this is crucial to becoming a better physician.

    I will add that I do truly understand your feelings – I nearly failed the beginnings of our gross anatomy course, and did so after killing myself with work and never seeing anyone. At that point I resolved to still have a life and to find ways to make school work, and that if I couldn’t do that (and thus failed out) it meant that I truly wouldn’t be able to handle medicine. As a result, I found better ways to study, did markedly better, and managed to spend plenty of time on things I wanted to do (like completing my first Ironman – I’m not saying that to say “good for me” but rather to illustrate that it is possible to have enough time outside of school to do plenty of other things).

    Good luck!

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