01 April 2007

the paradox of perspective

a few days ago, my friend j.p. blogged about her frustrations with the healthcare system and being a patient in it. today i discovered a recent blog entry from dr_couz (a FP resident in Canada who writes a wonderful blog about her experiences in residency there) discussing the lines physicians must draw between their personal and professional lives. now here i sit, pondering the paradoxical perspectives.

on one hand, dr_couz's commentary on boundaries hits me hard. i have a hard time keeping and maintaing boundaries (but, no, i don't have a "caretaker" personality or anything! ;-) ) and i've watched many a physician get burned by an inability to balance work and life or friends and patients--or both. most recently, a wonderful geriatrician spoke to our class after her last day in private practice. she's hardly retirement age; yet, she's retiring. when describing why she's chosen to take "time out" from being a physician, she told us a story about how she recently sent her husband to a patient's house to fix the patient's leaky shower head. yes, we live in an area where there are many elderly people in need of assistance in one form or another--but it took her getting that involved in her patients' lives to realize why she had burnt out. she simply became over-involved. this physician stood in front of my class and told us, point blank, to maintain our boundaries. she's a sobering example of what can happen when one crosses too many lines.

so, i get that i'll need to be cautious when i go into practice (if i ever get there!), because i know i have tendencies to be like this geriatrician, to want to fix everything. [i'm pretty good with a wrench and plumber's tape, actually. ;-) ] but i also must wonder, what about the fire?

my friend j.p. eloquently captured her rage at the healthcare system and at doctors in particular. she's encountered at least a hundred (if not more?) physicians who have been distant, absent, and even downright cold. many have not been well-versed in their own specialty, let alone anything remote to it. one could argue, perhaps, that this is just one person's perspective. and, oh, how i wish that were true. but it isn't. i know because her words resonate with my experiences as a patient. her question--wanna be my doc?--has also been asked of me many times, by many friends (and even some strangers!) in similar situations. this is being asked. of me. the first-year medical student....

one of the reasons i am a first-year medical student, though, is because i feel the fire, the rage, the dissatisfaction shared by so many patients. it's an emotion that can't--indeed mustn't--be ignored. thus i'm left to wonder: given that i cannot be physician to the masses, given that i am human and will make mistakes during my career, given that i have to be able to take care of myself as well as those around me, given all the barriers present in healthcare, how can one person make a difference? how do i remain open to people, to learning, to the tenets of my profession when it seems that so many physicians give up, burn out, or sell out? and how do i become a decent physician if i can't manage my own healthcare problems? if i cannot take care of the people i love? if i pin the essence of primum non nocere to my heart, will i always remember?

once again, all i'm left with are questions.

speaking of which, hey j.p., wanna come to med school? ;-)


j.p. said...

wait a sec, i don't even know if i'll get into grad school (gotta get that app done first, huh?), and i know i'd never get into med school.

maybe if i'd had a doc who'd known what they were doing about twenty years ago or so, and learned how to deal with my adhd back when i was a kid instead of having to learn how now, i would've gotten through school a little more easily. but, with my ed history, med schools would simply get a good laugh. ;)

in response to the question you posed at the end:

you'll be a good physician because you know what it's like to wear that stupid paper gown, to get pricked with a thousand needles, to have test after test run without getting a single answer, to be spoken to in condescening and patronizing tones, to sit on the cold table and wait, to sit in the waiting room and wait, to sit after lab tests, and wait.

you'll be a good physician because at your core you are a person of compassion; you are a person who has experienced pain; you are stubborn enough to go to a post-bacc program and study for months to do well enough on the mcat and to apply and apply and apply so that you can help others - and you will apply that same stubborn persistence in trying to find answers to your patients' problems.

and yes, you will struggle with boundaries. you will struggle with watching people suffer. you will struggle with not finding answers to every person's problems.

but you will do all you can the best you can. and you know that if you ever need help putting things back into perspective, you have people around who can help. . . or you can call me and i'll make you laugh. :D

student dr. blaze said...

hey, who is to say you couldn't get into med school?!?!? remember, i was the one that said the f-word during the interview and they let me in.... then again...it is mwms (<--a play on samuel shem's book "the house of god," where he refers to harvard as mbms = man's best medical school. mwms = man's worst medical school.)....

i hope you're right about all this. and watch out--your phone might start ringing off the hook. there are at least 160 people in this town who could use a good laugh right about now. ;-)

a little disclaimer...

i'm a medical student. just a student. so please, don't take anything i say too seriously. remember that i was an english literature major as an undergrad, so there is much fiction to be found in these pages. do you think i'm telling a story about you or your illness? more likely, you're tapping into my sense of "everyman"--that is, your story resonates with what i write here because it's not so uncommon after all. need help? please, please go see your physician. <--i'm not her. yet. ;-)