As a patient who has had extensive dealings with five prestigious Manhattan medical institutions, I have taken the liberty of writing this letter from the perspective of one who has spent many long and arduous years in the underbelly of our deeply troubled health care system, and one who has seen firsthand how the doctor-patient relationship has steadily eroded over time. This relationship, so foundational to the practice of medicine, is in crisis.
While doing your undergraduate degree, it is important not to spend all your time shadowing, taking science classes, and preparing for the MCAT. Study literature, history, and the arts. In the absence of a humanities education, people are transformed into automatons and desensitized to the suffering of others. With the dramatic rise of specialization, the importance of the humanities only increases.
The first question every doctor should ask when walking into an examination room is “How are you?” — not “How is your gallbladder, retina, or liver?” — but “How are you?” In this way, you are acknowledging that the patient is a unique individual and not merely a malfunctioning organism.
I’ve been fortunate to work with some of the top specialists in New York City. The problem is that while an otolaryngologist was an expert in a tumor I had in my neck, a surgeon was an expert on the state of my liver, and my gastroenterologists have varying ideas regarding what may or may not be going on in my stomach, most of these physicians know nothing about me as a person. How will a good rapport be established, if a physician only talks with a patient about a highly specialized thing, scarcely even acknowledges their other medical problems and is in and out of the room in minutes?
A line from the Hippocratic Oath reads: “I will remember that there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug.” If a patient complains about the compassionless care they received from another department or institution, listen. Listen to what your patients say about that which may appear on the surface to be of a non-medical nature. They are connected.
Another passage from the Hippocratic Oath reads: “I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.” Some patients may not want you to observe their doctor’s visits. Do not take this as a personal affront. One day you too will wish to meet with a physician in private. They are not trying to sabotage your medical training. They may simply not want to be examined with someone else in the room, or they may have a delicate matter that they wish to discuss with their doctor in private.
There has always been an innate power imbalance in favor of the physician. The presence of unwanted observers during an office visit magnifies this power imbalance a hundredfold. The patient’s need for privacy, confidentiality, and dignity must be protected at all times. If you fail to respect the emotional well-being of your patients as a medical student and resident, what kind of amoral villain will you become when you are an attending?
Do not dissemble. Speak respectfully to your patients, for one day you will also be a patient. If a patient has a needle biopsy done on a mass, and the pathology indicates that it is benign pending resection, do not tell the patient that the mass is unequivocally benign.
Failure to disclose common long-term chemotherapy side-effects or long-term side-effects from other powerful drugs is likewise immoral and indicative of an egregious violation of patient trust. Some would argue that if a patient were educated in regard to these side effects, they might choose to opt out of treatment altogether. This is nothing more than a base and cowardly attempt at rationalizing the absence of informed consent.
Speak in the language of the layperson, but do not patronize. Never leave an examination room without asking the patient if they have any more questions. Always be mindful of the emotional, psychological and physical vulnerability of the patient. Take a deep breath. Let time decelerate and be unbound.
If an attending instructs you to do something that is irrefutably unethical — such as perform a practice pelvic exam on an anesthetized patient — defend your sacred oath to do no harm. Do not obey. Organize.
A line from the Hippocratic Oath reads: “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems if I am to care adequately for the sick.” Implementing a single-payer national health care system that puts human needs first while removing the profit motive, is the only answer to our disastrous and reeling health care system. Do we really want to live in a country where health insurance is tied to one’s job, and where do no harm is increasingly applied to a privileged few?
The for-profit multi-tier health care system is a pox on our society and diminishes us all. It has deprived millions of adequate care, while ruthlessly exploiting doctors and stripping them of their autonomy. This is a system that continues to bankrupt patients while driving physicians to such depths of despair, that some see no alternative but to take their own lives. It is in the interest of both the doctor and the patient to fight side by side for single payer.
While you may be tested by pernicious and malevolent forces, never relinquish your humanity, compassion, and sense of empathy, for without these things a doctor is but a burned-out husk and a soulless lifeless shell. And with these words now imparted, I wish you godspeed in your journey.
David Penner is a writer.
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