Monday, August 25, 2008

Changing Perspectives

As I have mentioned before, one of the most exciting parts of this year has been speaking to healthcare professionals and students. I suppose, after the last 8 months of peeking behind the curtain, I have changed some of my perspectives.

I see the kids, and I now see they are kids, in med school and I think about myself at that age. What were you doing at 23, 24? I was thinking about boys and trying to figure out how to live without mom's cooking. And what are these kids doing? Facing a mountain of school work and trying to stumble around the floors without killing anybody or making a stupid mistake. At one of my lectures I was listening to the teacher reprimand the class for not getting homework in on time. This is not the vision in my head when I think of my intern or resident. The white coat can be so convincing, can't it?

I feel for these kids. They have a huge amount of information to digest while working with patients and being the low man on the totem poll on the floor. Guess how much they get taught about having compassionate conversations? Guess how much they learn about what it's like to be a patient? Guess how much they get to practice delivering bad news before they actually have to do it?

You guessed it: rarely to never. I am often told by students (of all kinds) that my lectures are the extent of their education on patient perspective! How could that be?

When I look into the audience, I see some people who look grounded and some who are older and have wisdom written on their face. Occasionally, I am approached by a med student, nursing student, etc who has survived an illness and really 'gets it'. I have had a few who told me they have had to "tune me out or they would cry"--they didn't want their peers to know they had an illness. Mostly, I see young girls and boys who haven't a clue. They have lived "normal" lives filled with sports and clubs. They have not had an illness and probably have never been very close to someone who has. They may have never even seen death before.

And now, here we are, filling their minds with chemistry, biology and anatomy. There is a big piece missing--how do you interact with patients? You can't interact effectively until you feel comfortable so how do you feel comfortable talking to patients? You can't feel comfortable until you have a framework for what it feels like to be in a similar circumstance. Where do you find this framework? Without this framework, you are lost, say stupid things, and grow to dread having a conversation.

Where this discomfort leads is up to the individual. Some work at it, on their own time, and become compassionate and skilled caregivers. Some decide the discomfort is no worth the effort and go on the path of the stereotypical doctor--cold and very cerebral.

But is that their fault? Would they have taken a different path if more time in school was dedicated to cultivating these incredibly intimate human moments that health professionals are part of every day?

And my new-found sympathy goes even farther. I think us patients are often too hard on doctors and nurses. We pick them apart. "Did you hear that? Why did he/she just say that? Wasn't that rude? Can you believe he/she just said that to me?"

Guilty. I've heard people do it and I've done it myself. There is almost a satisfaction out of proving that your healthcare provider is a jerk. Why? Do we need to tear them down because we feel inferior. Are we projecting our anger about the illness onto the provider?

We all say stupid stuff sometimes. We all say things that come out wrong. We all say things we didn't mean and regret it later. Why, then, when a doc or nurse who is usually kind and considerate says something a bit out of line does it become a criminal offense?

And then, here's the biggee: They actually can't figure things out sometimes. Sometimes they are baffled by illnesses and sometimes they are baffled by people.
Sometimes, they want to help us but they can't. They are limited in their scope of knowledge. Sometimes, they want to help us but they can't figure out US out, the way we act, talk, the way we feel about things. We can be a bigger mystery than our body!

So, here's what I'm saying--we have unrealistic expectations about our healthcare providers. We don't cut them slack for being falliable humans. So why is that?


This is part of the breeding in school. Doctors are the quintessential "Fake it Until You Make It." They have never placed a central line but it is thier job to reassure us and act as if they have everything completely under control. They are terrified of breaking the news but they have to act calm and cool. They don't know as much about our illness as we do but they have to present themselves as the authority. Why? Training.

I dream of the day when the curtain is pulled back and we will understand each other as humans and partners. Not authority and pittiful case. I dream of the day schools teach patient perspective and the art of communication and consider it essential for good care.

Recently, I had a healthcare provider giving me my PFTs (Pulmonary Function Test). She was new, it was obvious. I have been doing this since I was a child. You can tell who is new and who is uncomfortable. She made me do all of these useless things while forgetting the important stuff like my nose clip. She was very invested in presenting herself as an authority and I was amused. I was able to step out of myself at a time when I would normally be extremely annoyed. I saw her as scared and I felt compassion for her and amusement at her need for silly rules.

It felt good to feel for her instead of hating her in my mind. It felt good to defend my doctor when someone was telling me a story about how stupid he is. It feels good to open the curtain and find the similarities, not the differences. It feels amazing to see my providors as peers, not superhuman. I feel connected to them, I feel compassion for them, I feel in awe of them. They are me but with a different job description.

Us patients put professionals on a pedestool. Let's take them down from there--it only causes resentment and disapointment.
Professionals, take a chance on us and let's change the culture of healthcare.

In the meantime, I am so happy I got a look on the other side of the curtain. I like my healthcare better when it's humanized.

With Gratitude!


Laurie said...

What a great post!!! Very insightful and compassionate. Science is a huge part, obviously, but without the patient interaction, it's just data.

I agree, there is a tendency to be so quick to bash a doctor, when in reality we're in this together and need to work with each other to reach the ultimate goal--better health.

Jill D said...

You hit the nail on the head! I was in med school at 22, 23, 24 and a newly minted MD just shy of my 26th birthday. I knew going in that my CF experiences as a patient would make me unique in a world where your peers have never known what it's like to be a patient. You really don't know what patients go through until you are a patient yourself. I think all med students should be forced to be an inpatient for a week just to see what it's like. Med schools don't teach you anything about that. And I think it's an invaluable skill set that made me a much better med student and doctor.

Dragonfly said...

We like the humanity as well.

SeaSpray said...

I enjoyed your post!

I've been a frequent flier to my urodoc's office and the hospital since winter 06..well with a reprieve from being sick for 16 months and then it started again in June.

I have been blessed with the most amazing doctor that I still blog good things about him and can't imagine going through all that I have with out him. I've never knocked him or another doc I have been close too. If I felt negative..then I wouldn't go. I have to have a bond...that's just me.

I wrote a post last fall "The Conflicted Patient" (on my sidebar) in which I discussed my difficulty being a patient when I am so used to working on the other side of the desk... as opposed to looking up at staff from the stretcher.

I think I have always been sensitive to patients but I can tell you that after so many OR procedures, inpatient stays and doctor office visits...well... I will be even more sensitive to patient needs.

It is not easy being a patient and I am most grateful for the 99% caring staff I have had involved in my care.

You have a great blog! :)