Practicing humanistic, patient-centered medicine requires doctors to stifle their humanity

STAT_LogoJust before the holidays, I was treating a woman with severe pneumonia. As I examined her, day after day, she told me about her family, their plans for Thanksgiving, and how much she missed her children. I liked her. I cared about her. I even used the promise of free Wi-Fi to convince her teenage daughter to come see her.

The day before she went home, as I had done every day, we talked about her treatment plan. A couple of hours later, I got a page — this patient was angry because she said she hadn’t been seen by a doctor that day. In those days of caring for her, I introduced myself as her doctor, I mentioned being part of her team of doctors, and I was prescribing her different medicines. All of these indicators that I was a physician, and she had no idea who I was.

At that moment, I felt so defeated. I’m often mistaken for something other than a doctor because I am female, young, and black, but it was more than that. I was disappointed because I had committed a lot of time and energy to her care. I had assumed that this would lead to some interpersonal connection — that we’d stand together in her journey to get well. I wasn’t prepared for the hurt of being abandoned on that journey.

I became a doctor because I saw something beautiful in helping patients overcome the agony and isolation of illness. I spent years training to build bridges with my patients, to listen, and to be empathetic. Medical schools are increasingly recognizing the importance of being “humanistic” practitioners. And patients tell us they want these healing relationships with us. They don’t want unfeeling caregivers.

It’s National Physicians Week, a time when doctors around the country reflect on the art of medicine. I’m wondering how to cope with these feelings and not get burned out. The more I open my heart only to be rejected, the less I want to risk opening it up again. How do you not become uncaring? I expect this rejection to happen many times over the course of my career, but if I become self-protective, am I setting myself up for failure?

Doctors are supposed to be selfless. “Selfless acts lie at the center of the caregiver’s soul,” says Dr. Rajesh Panjabi, a Harvard Medical School instructor at Brigham and Women’s Hospital. But caregiving is emotionally complex and draining work. It’s becoming harder to ignore the entangled mix of anger, dismay, and purposelessness that takes me by surprise.

I asked a social work colleague how she dealt with this. “I do my best, but I always have to tell myself not to want it more than they want it,” she said about forming that bond with the patient. “When you want it more, you set yourself up for disappointment.”

But is fair for me to expect more from my patients when, in the doctor-patient dynamic, the balance of power usually tips in my favor? I know it’s not, because my patient comes first. That’s part of what Panjabi is talking about when he says we need to be selfless. So, I struggle with the idea of practicing humanistic, patient-centered medicine that requires me to stifle my humanity and to make myself small or even invisible.

While my patient with pneumonia was successfully treated, I couldn’t help but feel something between us had failed. I’m always looking to learn how to replicate the more positive, healing relationships I’ve had with patients, but its easier said than done. There’s no guidebook.

After his young wife, Laura, suddenly died, Peter DeMarco penned an open letter in the New York Times to the staff at my hospital who cared for her. I was on the neurological team that examined Peter’s wife in the ICU.

“Every single one of you treated Laura with such professionalism, and kindness, and dignity as she lay unconscious,” he said.

He described the heavy moments when we “deliver[ed] bad news with compassionate words, and sadness in [our] eyes.”

A resident recently told me that it was nice to be recognized, but Peter’s kind words just reminded her of all the other times patient’s families had screamed at her.

“I don’t really understand,” she said. “We always deliver the same care.”

I’m forming my identity as a physician, and I still have a lot to learn. Perhaps the art of medicine lies in this tortured ambiguity. And maybe with time and experience we stop struggling against it, and grow into its embrace. In the meantime, I’m still striving to be a humanistic doctor, and I’ll hope for the best — for both of us.

Jennifer Adaeze Okwerekwu is a psychiatry resident and can be reached on Twitter @JenniferAdaeze.  She writes the Off the Charts column in STAT News, where this article originally appeared.

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