The unspoken culture in medicine has been that to maintain objective professionalism – some measure of distance is encouraged between the clinician and the patient. From anatomy lab, students are encouraged to forget patients as fellow human beings but organs and limbs. Medical rounds and board examinations reinforce that patients are diseases to be fixed. In some sense, such distance may be protective, as medical disease manifested in a human being in suffering, anguish, and loss.
Such pain is often foreign to practitioners, who throughout most of their lives, are healthy, well-educated, and socio-economically secure. Many of the diseases we treat in our professional domains are foreign in our personal lives. The medical system rewards perfectionism and competence, initiative and success, antithetical to the helplessness, fear, and tragedy felt by patients. The diseases doctors see are oftentimes too rare to be found in immediate circles or too senile to be found in anyone outside one’s oldest relationships.
As such, diseases remain problems to be solved and research questions to be answered rather than experiences of fellow human beings who suffer.
The introduction of COVID-19 into health care threatens everything that modern medicine has defined itself as. For many doctors, there is now a sudden realization that they can get the same disease as their patients have, oftentimes from their patients. A patient’s vulnerability suddenly becomes reflected in a provider’s own soul. COVID-19 is more than a scientific pathology, rather a real threat. Uncertainty is unnerving, but such uncertainty is no longer the physician’s to bear alone. The line between physician and patient has blurred.
This acknowledgment of shared humanity can respawn a human connection that can be lacking in modern health care. It can also be one of the most powerful tools we have to combat COVID-19. Doctors, with all of their technologies, remain helpless to the pathogen. There are no cures for viral infections, no operations to be done, at best we can intubate patients in respiratory failure, but that is mostly too little too late. For everything medicine has at its disposal, its two greatest tools are social distancing and the wait for a vaccine. We are frankly really bad right now at fixing the problems we are supposed to be fixing.
And yet, ironically, the public seems to hold the profession in higher regard than it ever has in recent years. Doctors are heroes again. Why? Medicine, when it has realized its technological limits, will always have its interpersonal elements, and these traits – passion and dedication, courage, and selflessness – are what the public has noticed and exalted. There is the recognition that physicians have the same fears and doubts as anyone else, but they face and overcome them. They have families and loved ones as anyone else, but they choose to rise to their duty for the greater good. Even just being physically and emotionally present with patients, who are isolated from their families during their COVID-19 admission, is viewed as magnanimous and noble. Some health care workers have even turned to play music to heal, to great results.
This should not come as too much of a surprise. Patients themselves have long reported that what they value most in a physician is communication, compassion, and caring. These values, upon which our profession’s laurels rest on, are old. These values are constant. They represent what is best in not just doctors but in all of humanity, character traits that are called for by patients in times of need. More than knowing much and doing much, doctors are demanded then, to be much.
Though medical training can, at times, stifle our original motivations for entering the medical profession, COVID-19 can be a catalyst for medicine to return to its noble roots. More than board scores, research publications, and other imposed quality metrics, the immediacy of COVID-19 serves as a reminder that medicine is about a simple thing at its core, doing what is best for the patient in front of you. This patient is a fellow human being who shares a common human experience with you. And when physicians do their best for that fellow human with honor and dignity – the same values that have empowered generations of physicians who have come before them, they become the heroes that societies have always needed.
Johnathan Yao is a medical student.
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