As a doctor ready to finish my residency in anesthesiology, most people would assume I am thrilled to be at the finish line of this long, challenging and grueling process. While I am happy to move on and begin practicing on my own, I am also somewhat terrified of what lies ahead. It’s not caring for patients that I am afraid of, but the cultural state of medicine in the 21st century that I am worried about.
Medicine has never been any safer than what it is now. Vaccinations have eradicated common diseases that killed millions. Dangerous medical procedures are now safe, and kids born with congenital defects have more hope than ever. I am appreciative of the safety of the current state of medicine. However, there is another part of medicine, equally as important, which I believe is in a constant state of atrophy and disappearance; the human touch.
Let’s take a step back into the dangerous era of 1950s medicine. Anesthesiology, being a relatively new field, was riddled in morbidity in comparison to today’s practice. No continuous EKG, no pulse oximeter, no end tidal CO2.
You mask a patient with ether. You intubate. You listen to the lungs, you look at the patient’s color, listen to their heart. Bellows go up and down. You watch the chest rise. In essence, you are connected to the patient; medicine is personal.
The human aspect of medicine inspired my journey to become a doctor. As a first generation Mexican-American, I had the amazing opportunity to spend my childhood summers in a small town in Mexico. My great-aunt, a Catholic nun who helped manage a local hospital, would host my family. The convent and guest room was in the hospital.
I would constantly roam the hallways of the hospital as a child. No administrators, no “children not allowed” signs. I remember being about 6 years old when I saw a man stumbling in the hospital. He had just been in an automobile accident, hand severed, bleeding. Those were colorful memories, full of life, inspiration, and energy. People were poor, but rich in many other ways.
As a husband and father of 2 beautiful young girls, I am afraid my daughters will never experience a humanistic experience like I had those summers. Without a doubt, those summers helped inspire me to become a doctor.
Medicine has become gray, opaque, litigious, lifeless.
Lets look at the current psychological state of our doctors-in training. Recent reports show that depression rates in residents can be as high as 43 percent.
And how about the quality of our training?
Recent studies have shown a perception of un-readiness, among older surgeons, about the preparedness and training of newly minted surgeons. Additionally, many young surgeons also state they do not feel adequately prepared for practice.
What’s the answer to this worrisome trend? More simulation, more mannequins, more time out of the multiple years of training that our surgery colleagues spend away from their friends and families.
How about limiting our hours? More sleep? A recent study found that limiting trainee hours on service leads to more mistakes. There’s no doubt working 30 hours straight is counterproductive and dangerous. But slashing doctor hours is not a silver bullet for better training.
How about letting us practice? Letting us make mistakes? Letting doctors run hospitals and write health care legislation? Or letting us build our own experiences much like the countless stories older attending physicians gloat about in the OR? “In my day, we would …”
Surely patient safety should remain a priority at all costs. I am not advocating that we sacrifice patient safety for the sake of our training. A balance that optimizes patient safety and trainee experience is an achievable goal within our current model.
Our world as residents is filled with paperwork, algorithms, ICD-9 or 10 codes or whatever; anything but human interaction and independent thinking.
We all became doctors to care for people, to heal, touch and talk to patients.
Re-introducing the human aspect of medicine, the real practice of medicine, is a cultural step we must take to inspire current doctors and those considering the field of medicine.
Cesar Padilla is an anesthesiology resident.
Image credit: Cesar Padilla