The attending physician looked concerned. My fellow medical student’s face was wet with tears. I knew the next words out of the attending’s mouth would be “Are you OK?” and indeed they were.
I have encountered this phrase many times, almost exclusively in psychologically traumatic situations. It’s a reflex response to an uncomfortable social situation, the “right” thing to say to a student in distress.
As medical students, we learn and practice the art of talking to patients in non-judgmental, open-ended ways. We are expected to become adept at communicating information as a way of not only respecting our patients but as an essential tool in being successful and competent physicians. So, in a field where our outward interactions are studied and refined so diligently, why do we address our colleagues so ineffectually? In the same way that your patient is deserving of an empathetic and open ear, so is your medical student, your intern, your colleague, and yourself.
So why do so many of us use it? It’s low-hanging fruit. On a busy clinical day, it provides an easy way to get credit for being empathic without truly debriefing. One student described a difficult experience to a group of fellow students and recalled the uselessness of being asked if he was OK. Of course, he said he was fine, even though he wasn’t. The team may have assumed that he did not want to talk, that he had other ways of processing, or that the school’s student wellness team had a peer counselor who he’d reach out to if necessary. Perhaps the team may have even felt uncomfortable themselves. Either way, they used his response to a yes/no question to close the conversation.
“Are you OK?” also affirms the power hierarchy. As the lowest ranking team members, medical students often feel that they should not share their true emotions or opinions. Many worry about being viewed as weak if they express their true feelings, and fear poor evaluations.
Sometimes the question may even feel like a challenge. In the same way that it seems impolite to answer “How are you?” with a response rife with distraught and anger, it can feel overly bold to say, “No, I am not OK.” Some students may feel that their attending physician’s previous culture of medicine emphasized the “old school” doctor who believed that it was appropriate to suppress their emotions. While there are plenty of attending physicians and residents who use the phrase in a well-meaning way and would welcome an honest response, it can be hard to assess in a moment of anxiety where one’s supervisor stands on the spectrum of understanding.
Medical schools and residency programs boast about their wellness programs to attract candidates, often accompanied by a plug for a program’s mental health resources. Shouldn’t we, as colleagues in the difficult and emotionally challenging practice of medicine, take the first step in approaching one other with compassion? Human interactions are not formulaic. There is not a single phrase or gesture that I can suggest. I can only offer that if you are a senior member of an academic medical team, the next time you see a team member in distress, approach him or her with the same open-ended language and sense of compassion that you were trained to do with your patients.
Anya Golkowski Barron is a medical student.
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