Acknowledge the human aspect of our medical experiences

Recently, a lot of my classmates have been passing around a New York Times article titled “Medicine’s Search for Meaning,” a piece detailing the high burnout rates of doctors-in-training and the inadequacies of medical education to address physician wellness. What I found to be of the most saddening paragraphs in the article goes as follows:

Nearly half of medical students become burned out during their training. Medical education has been characterized as an abusive and neglectful family system. It places unrealistic expectations on students, keeps them sleep-deprived, overstressed, and in a state of fear of making mistakes, and sends the message that doubts or grief should be kept to oneself. While the training formally espouses the ethics of empathy, compassion and altruism, doctors and researchers say that the socialization process — the “hidden curriculum” — teaches something very different: stay detached, objective, even a little cynical. Five out of six doctors say that medicine is in decline and close to 60 percent would not recommend it as a career for their children (pdf).

I can only speak from my experience attending medical school at Stanford, which has been an overall incredibly supportive environment. We have Educators for Care, designated faculty members who mentor us throughout 4 years or more and meet with us regularly to discuss wellness.

We have a Physician Wellness Committee that promote well being through exercise, lecture series on wellness, and a peer counseling program. All of these resources are great, and I appreciate Stanford making wellness a priority. But personally, it is hard to take time out of clinics to attend events or put extra effort into incorporating wellness into my life. I think at a very basic level, a cultural change needs to take place in our medical schools.

I’ll start with a story. It was my first day working in the neonatal intensive care unit (NICU) on my first rotation of my third year, and minutes after I arrived, I was brought to one of the beds where a baby was being taken off life support. She was born the night before with malformed lungs and a variety of birth defects incompatible with life.  The NICU team had tried various things throughout the night, keeping the baby on a ventilator to buy a little more time while various services came by to assess possible interventions. By the time I came to the scene, the team had discussed with the parents that there was no way to save their newborn girl, and that it was time to remove care. “This is a rare thing to see,” one of the residents told me. “You should come watch.”

I stood in the back corner of the room helpless and nervous as multiple physicians and nurses gathered around the tiny baby. The parents sat in the room, the father’s arm wrapped around the mom’s shoulder. I watched as the baby was extubated, and after a few agonizing moments, the newborn was pronounced dead. Both the parents broke into heartwrenching sobs as they watched their baby die in front of them. I didn’t know what to do. I wanted to comfort these strangers, but I didn’t know what was appropriate for my role. I clumsily offered up a box of tissues to them, and felt relieved when they took it. I hid in the back of the room after that, tears streaming down my face, feeling overwhelmed with sadness for this couple and their baby. The nurses wrapped the newborn in blankets and gave her to the parents to take to the grieving room, where they sat with her for the next 15 hours. And I? I went straight to orientation, where I was given a tour of the rooms, an overview of my responsibilities, and which patients to pick up. No one mentioned the death, and I felt embarrassed to have been emotional when the rest of my team just picked up and moved on.

That same scenario played out multiple times in the next few years. Breaking the news of metastatic pancreatic cancer to a patient who thought he was just a “little under the weather.” Telling a family that their loved one did not survive the surgery. I understand that doctors face death constantly, and after time, they learn to accept it as just a part of their job. Becoming too emotional or involved can hinder doctors from doing their work efficiently. But what I don’t understand is why I felt ashamed to express grief in the hospital. It seemed to me that feeling too much was a sign of weakness, and no one wants a weak doctor. I thought I was alone because no one talked about these experiences openly.

That is where Dr. Rachel Remen’s course, the “Healer’s Art”, comes into play. Dr. Remen is a physician at UCSF where she started a course in 1992 focusing on the humanistic aspects of doctoring, tackling topics such as healing, loss, grief, and mystery. She believes that physicians must learn to heal others by learning to heal themselves first, and she helps doctors achieve this through small group sharing in a safe and confidential environment. When I was at NBC, I sat in on an editing session for the following segment we did on her very interesting work, which you can view here:

Before going through clinical years myself, I didn’t understand the importance of such a class. Many of my classmates thought it was a waste of time, calling it that “touchy feely stuff.”

But honestly? The more I experience in medicine, the more I realize that every physician could benefit from having some time for reflection once in a while. It doesn’t necessarily have to be in a structured group or class format. But the things we experience in medicine are sometimes so bizarre and beyond the scope of normal human experience that afterwards we have to pause a moment to take it in, react to it, give ourselves permission to feel. It’s a myth that the best physicians are the stoic ones who put a wall between themselves and their patients.  I strongly believe that by acknowledging the human aspect of our medical experiences, we become better doctors who can relate to our patients and burn out less from the profession.

Joyce Ho is a medical student who blogs at Tea with MD.  She can be reached on Twitter @TeawithMD.

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  • PracticeBalance

    Thank you for your article! I am very interested in the course idea and wish other schools would catch on. As physicians, we become hardened to the emotional scenarios but we also seem to adopt a feeling that we are immune to having our own medical problems. I ignored nonspecific symptoms all through residency, blowing them off as depression or stress, to find out that I had a brain tumor! I urge all medical students and residents to start learning about THEMSELVES now – what makes them tick, what helps/hurts in terms of stress management, how to listen to their own bodies.

  • Ron Smith

    Having been through that almost exact same scenario with a child who had Potter’s syndrome some 25 plus years ago, I can tell you that your description brings back fresh memories.

    My Laura was 24 years old and suffering from the results of severe fetal isotretinoin embryopathy…exposure to accutane. She suffered a severe spontaneous bleed of the brainstem. We stood sobbing with our family around her little PICU bed at Scottish Rite in Atlanta as we watched heart rate fall and finally cease. Two or three small insubstantial gasps for respiration was all that her injured breathing center had left.

    Now what I’ve just described to you is in the terms of a physician with 30 years experience who has seen he share of children pass. What I will tell you that is most important is that just as with Laura, none of my patients are ‘interesting cases.’ They are people that I became attached to and loved deep in my heart.

    While you may think that your tears somehow proved you weak and incapable, I see nothing less than the absolute strongest character trait of you as a physician and a human being. If your clinical skills become separated from that part of you, then no matter how good a physician you are, you are missing the best part of medicine.

    Life is hard sometimes. I get to be a part of it with the patients and parents that I become attached to. I know their pain. Not only were those physicians and nurses who took care of Laura my colleagues, but they became my friends. When patients suffer, they need to know that we physicians care. Its OK when their suffering pierces our hearts. That just means that we are human, broken and needy.

    I hope you will be encouraged. Because of the first 30 years, I think the next 10 or 15 will be some of the best clinical years of my life. Life is hard, but then we are physicians, nurse practitioners, and physician assistants. What else would we expect?

    Warmest regards,

    Ron Smith, MD
    Laura’s story is a free, small ebook on iTunes, “Forever And A Day For Laura Michelle.”

  • meyati

    I was thinking of this last night. This was in the 1960s, when things were far different. I went in for my monthly OB exam-third kid. All of a sudden, my Navy doctor asked me if he could talk to me. He had the saddest face. He told me that about 2 weeks earlier they delivered a baby with several different advanced cancers. The mother had gas, so she didn’t hear her baby’s agonized screams. Each time they touched the baby, he screamed in agony-the chart showed that the husband was deployed. My doctor gave the poor baby a shot of morphine. They told the mother that the baby was still born, because of her husband being deployed they sent her son to the mortuary. The mortician gave her the story that because they were waiting for her husband to get home, the casket had to closed. They also kept her heavily sedated in the hospital, until her husband made it home.
    The doctors talked about it several times at their meetings, where they shared knowledge and gave emotional support to each other. This young doctor didn’t want to talk to his wife about, she delivered the same day I did, and was about 20 beds down from me.
    The first thing I said, “Oh dear Jesus, that poor baby and mother. I can’t imagine the pain that baby was in. I hope that you gave him the morphine quickly. If she knew this, she might think that she did something wrong or god was punishing her. this way she won’t be scared to have another baby.” He let out a sigh and cried, thanking me for understanding. He thought that the doctors were doing group think, and an outsider wouldn’t understand. We talked about god, my father died from cancer, cancer, We talked about how some oncologists would have wanted to experiment on the baby, as they put their 2 cents in after the autopsy. After that when I saw him, I asked him how he was doing.
    I think it’s horrible that they have to have a class about doctors talking to each other. That doctors feel ashamed to cry or rage, to be human.

    My son is a disabled vet, if I could make him whole again-I’d throw my self into a volcano. I’d want to murder any doctor that would want to keep a cancer filled newborn alive, while an inhuman committee made assessments. Many other conditions are just as bad.

    I don’t care much for modern medicine very much, and I’m so sorry for the young doctors.

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