Vulnerability is a virtue in medicine

Medical students are repeatedly taught the importance of the physician-patient relationship.  We are told that to be a good doctor we must strive to exhibit compassion, empathy, respect, professionalism and confidence all while applying our medical knowledge to figure out a diagnosis and treatment plan. If you add in the pressure of doing this within a 15-minute visit, all while answering questions faster than an Internet search, it can get overwhelming.  But where does vulnerability fit into the equation?

We all have had vulnerable moments in our lives, and most would agree it was not a good feeling. A quick Google search will describe vulnerability as, “A susceptibility to physical or emotional attack or harm,” with common synonyms including, “helpless, defenseless, powerless, and weak.” If a word can have so many harsh connotations, why should we look for it in medicine?

As a medical student and physician, it is very easy to fall into the trap that we must desensitize ourselves. Many tell us that we must compartmentalize our emotions in order to survive. It makes sense as health care providers are constantly surrounded by sick patients: some getting better and others who are not so fortunate. If physicians opened themselves up emotionally to every patient they would simply not be able to cope. Although the thought might be nice, the idea that physicians are superhuman is incorrect. Doctors make mistakes, experience heartache, and need outlets to express themselves. However, there is a mindset in medicine that as health care professionals we should not show our emotions. This lack of vulnerability is not only hurting patient care, but our own well-being.

Brené Brown, a research professor at the University of Houston, has looked at the power of vulnerability and how it applies to the human connection. Dr. Brown defines vulnerability as the “courage to be imperfect and the compassion to be kind to yourself and then to others.” She discusses that vulnerability is necessary for effective human connection and leads to authenticity, thus enabling us to truly connect with others. This authenticity is what is most important in the physician-patient relationship. Many times throughout medical school, we hear that the patient has the ability to lead us to the diagnosis before any diagnostic test. We want our patients to be transparent with us when we delve into some of the most intimate questions, exams, and diagnoses all within minutes of meeting a person. Physicians need to partner with their patients, rather than simply treat disease. This approach will yield optimal results in a patient’s health care outcome.

I had first-hand experience of the lack of empathy and vulnerability in medicine.  During my final exam week in the first year of medical school I was not in front of a computer taking my exams, but instead standing in a busy emergency room watching a middle-aged woman fade away as she suffered from an aortic dissection. That woman was my mother. I watched as they prepped for the emergent operation in an effort to save her life. The surgeon walked into the room, asking if I was the “medical student son” and stated plainly that she was not going to make it. He proceeded to talk about the pathophysiology and etiology of the disease. I will never forget how he described the patient as already going into shock and this surgery would be a last ditch effort to save her life. This surgeon was telling me the horrible prognosis with the mentality of physician to medical student, not from human to human. These dialogues happen so many times in the medical education, but when you are on the wrong side of the conversation it becomes much more apparent how flawed this approach is.  It was simply a disease with teaching points in the surgeon’s eyes. There was not a unique individual with likes and dislikes: no mother, daughter, or my best friend.

This experience gave me an entirely new perspective on practicing medicine. It reaffirmed my advocacy to embrace the side of medicine that unites us all: the underlying human nature of our emotions. My mother would always tell me that I must be the doctor who knew the color of all of my patient’s eyes. Of course this is impossible, and I joked about how ridiculous the statement sounded any time she said it. However, looking back I now know exactly what she meant.

Dr. William Osler said that “it is much more important to know what sort of a patient has a disease than what sort of disease a patient has.” I challenge those in the medical field to be more vulnerable, embrace your own emotions and never let your ability to connect with a patient, another human being, go numb.  Vulnerability is a virtue in medicine. Remember it is a person, not a disease you are treating. It should be acceptable to shed a tear after giving a difficult diagnosis, hug a patient after a medical triumph, or speak to colleagues about how you are feeling after an emotionally draining day. After all, we are all in this life together, and although we may not be able to know the color of all of our patient’s eyes- we can definitely see and treat them more than simply a disease.

Michael Metzner is a medical student.

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