It wasn’t very long into medical school when I realized that the role of a physician feels just like that—a role. As a former high school thespian, I recall my Step 2 CS exam feeling a lot like a series of auditions—convincing twelve standardized patients that I was a competent physician with an abundance of clinical knowledge and the ability to remain cool under pressure during the notorious “curveball” questions that are a signature of the exam. Being professional is something that consistently defines the profession and is a standard that any future physician must subscribe to. As a black female in medicine, I knew situations like these would arise, such as the time I was called the N-word by a patient while assisting in reducing a humeral fracture as a fourth-year medical student. However, I was still confident that both my training and lived experiences would set the stage to play my role as a caring, competent physician. But then COVID-19 happened. And with racial tensions as well as mistrust in the U.S. health care system at an all-time high, it is evident that in these unprecedented times, we must continue to be professional, while safely acknowledging the simple fact that we are approaching a new era in medicine. An era that celebrates our humanity and truly encourages diversity of patients and health care providers. But how do we do this? We have to stop being actors.
Doctors, much like successful actors, are given a platform by society. We are given access to people at their most vulnerable—we inform them, we medicate them, we cut them. For this reason, it is paramount for a patient to trust their physician. However, in attempting to be the “perfect physician,” we still have to promote patient agency and education. Even after just a few months as a surgical resident, I have noticed that it is difficult to truly take the time to make sure that the patient understands a key diagnosis or intervention, and I struggle between efficiency and thoroughness, especially in a medically underserved city like Detroit, where numerous studies have shown that in predominantly African American patients, health literacy is positively correlated with education level and negatively associated with age, and is an important determinant of disease-specific illness beliefs, such as in the management of acute heart failure. In contrast, I experienced patients with a solid level of health care literacy while rotating at hospitals like Cedars Sinai in Beverly Hills. Despite this difference in both populations, the reality is that as physicians, we often treat patients much like how a performer treats their audience—as if there is a fourth wall, an invisible partition that separates us from them. Many patients at baseline are not advocates for themselves and are often told what to do or what to take. Which begs the question, is it the physician or the social institution of medicine that is failing our patients? And are we failing patients more on a microscopic or macroscopic level?
In many ways, the answer seems obvious—yes, to all of the above. A recent national cross-sectional survey focused on the major reasons people avoid health care, where over one-third of participants (33.3 percent from a data set of 1,369) reported unfavorable evaluations of seeking medical care, including their impression of physicians, which was further divided into interpersonal concerns and concerns about the quality of care. Major interpersonal concerns (n=34) included the perception of doctors, such as difficulty communicating and disliking how doctors communicate or the manner in which doctors communicate. Regarding concerns about the quality of medical care, patients (n=61) reported low confidence in physician expertise in the diagnosis and subsequent intervention. In the wake of COVID-19, patients today are asking more questions, doing more research, and are more aware of the flaws in our health care system as we battle a novel health crisis. It is a struggle for physicians to assume an air of competency when the situation continues to rapidly evolve. Thus, now is a perfect time to reevaluate the role of a physician, and how we work with patients and amongst a health care team. There is no easy solution for tackling such a nuanced, systemic issue, but the evidence is apparent: physicians need to find a balance between being an effective communicator and advocate for their patients. However, part of the ability to provide effective patient care comes from a nurturing environment amongst physicians and health care providers.
Due to COVID-19, many physicians are finding themselves in a new position—a new state of uncertainty. Although we have been trained to be confident in our decisions, yet careful to consider all possible options, it’s hard to come across as a competent health care advocate when we do not entirely know what is going on—we do not truly know the long-term effects of COVID-19 let alone how to truly manage it today. It is these facts and these facts alone that essentially ruin this expectation of expertise amongst physicians. We are not these all-knowing, “Gods of Medicine.” We are scared too. We are confused too. So what does this mean for our patients? Specifically, in regards to patient care during a pandemic?
I wish I knew the answer. Starting a surgical residency is difficult without a health-care related pandemic looming in the background. However, the reality is that time will continue to reveal what we’ve held as “rules” in medicine as “suggestions.” Likewise, a shift in the playing field between physicians and patients, where both parties are learning about a terrible illness in real-time, may just be the unfortunate but perfect example of how the current system should change for the better, by prioritizing patient education while showing them that physicians are not heroes. We’re not actors.
Uche Ononuju is a surgery resident.
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