Although I didn’t think much of the statement when I first heard it from my residency director, now, nearly twelve years later, I realize its value. I learned so much during those three years. I learned to prepare for success prior to every procedure I started to avoid clumsily searching for needed equipment mid-procedure. I learned what an eternity of time I gained during an intubation if I could be calm and conscientious enough to pre-oxygenate the patient. I learned how to adjust the angle of the spinal needle when it met bone during a lumbar puncture. I learned a lot about how to give bad news (a skill I have not yet perfected). I learned to guard against hubris because I saw it hurt people.
Over the first decade of my career after residency, I have probably forgotten just as much as I learned. I have forgotten how to interpret invasive cardiac monitoring numbers. I have forgotten why IV calcium is a bad idea in the hyperkalemic patient on digitalis. I have forgotten how exactly to handle a shoulder dystocia during a delivery. I have forgotten the cutoff value between a positive and negative troponin (it does seem to change every month or so).
One strikingly basic dictum, however, seems to whisper to me daily as I continue my journey in clinical medicine.
“You’ve gotta like your patients.”
Upon hearing it as an intern, I remember thinking, “Well, duh. Of course I have to like my patients. If I don’t like patients, I made a poor career choice.”
But somewhere in the middle of residency, it became more difficult to like the patients. I grew tired of being constantly hungry and tired. I grew tired of spending an entire month working to become a serviceable apprentice pediatrician, internist, surgeon, intensivist, obstetrician, etc., only to start the entire process over on a new service and once again become the dumbest person on rounds. What was more, some of the patients were just so hard to like.
How could I like the cocaine abuser on his fifth visit of the year with chest pain? How could I like the schizophrenic who curses and fights everyone trying to help him? How could I like the obese and non-compliant diabetic who keeps gaining weight and comes in with another foot infection? The process dragged me down, and the patients began to drag me down further. I was beginning to see the frustrations of my next 30 years, and that was demoralizing.
What I didn’t grasp at that time is the reason I have to like my patients. It isn’t just to help them, although it has been proven that patient compliance is enhanced by a positive physician attitude. I’ve gotta like my patients because it helps me. Being a doctor is emotionally exhausting. When I like my patients, I sustain and renew myself to face another day on the rollercoaster of human emotions. In one day, my patients are experiencing pain, grief, despair, joy, relief, and inspiration.
Today’s doctors are unfortunately the face of the money-hungry monster of American health care. We hold little of the responsibility for the tens of thousands of dollars charged for a brief hospital stay, but we are the faces the patient remembers, so we become the reason for the absurd bill. The patients trust us less. Because they trust us less, they heed our advice less. When they don’t heed our advice, we feel less helpful. When we feel less helpful, we become nihilistic and more prone to burnout. But when we connect with our patients and truly enjoy spending time with them, they begin to trust us. When they trust us, they are more likely to comply with medication regimens and behavioral changes. When they do this, they see results and become healthier. When our patients become healthier, we fulfill our mission and get to celebrate their victories with them. I’m no linguist, but I’m pretty sure that celebration is the opposite of burnout.
There aren’t many things I can personally do to get American health care back on the right path. But, I can offer some borrowed advice to other physicians who are soul-searching and doubting what impact they have on their patients: You’ve gotta like your patients — to promote their health, as well as your own.
Thomas Paine is an emergency physician.
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