Medicine is about Relationships

In our training, we are taught that medicine is about facts. It is about figures. It is about classifying and diagnosing diseases. It is knowing the right treatment. It is about knowing the side effects.

But Medicine is all of those things, but that is not the heart of medicine. Over and above all medicine is about people, which means it is about relationships.

Sound strange to consider?

People come and see us, and we see people in the hospitals and the health care industry. We don’t see ‘illnesses and diseases’, as much as we learn to see people as those particular categories. We don’t see machines who automatically follow instructions – people come with their different understandings and approaches to health care. There are many facets to the people that we are seeing, and if we are not connecting with them and building relationships, we are not going to be able to communicate with them, and they are not going to be able to freely communicate with us.

How we relate to people is at the heart of how well we are able to practice medicine. The thing that hurts us most in life is how poor our relationships are or when there are relationship breakdowns. Medicine is no different and people are no different when they are seeking health care.

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To medicate or not to medicate. That is the question. Or is it?

In modern day times, pharmaceuticals have become the centre of medical treatments. We learn and indeed expect that when we go to a doctor that we will receive a script recommendation for a medication, a pill, to treat our ills. Many of us want that unquestioningly, want that little small thing to make the problems go away, and on the other hand, many of us are increasingly suspicious of medications. Some of us want medications, are in search of that little white pill to cure our ills, and then many of us do not want to take medications, no matter what, in fear of side effects.

These positions bring to light certain questions:

  • There certainly can be many side effects from medications. But are we to avoid them ‘no matter what’?
  • Is there in truth a place for medications in the management of our health? Or are we putting our health at risk by not taking medications?

People are not really ambivalent about taking medications, they are absolutely polarised.

I see people who want medications, and then those who refuse to take medications, and then there are of course those who have side effects to all medications, and then those who have no side effects to any sort of medication. Strangely, I don’t see people who are ambivalent about taking medications!

Our response to medications appears to be quite an individual thing, as much as our attitudes towards taking medications and this is to be respected and understood.

But what’s behind our desire to not take medications at all?

Whenever I prescribe medications, one of the common responses I hear is people tell me that they are ‘going to rattle’. Yet, medications are usually smaller than the proverbial tic tac – and people aren’t worried that they will rattle when they take tic tacs…… we happily have tic tacs, or other forms of food, several times a day with no issue, yet we resent having to take medications several times a day, or even once a day……..

So I wonder, what is it that underlies our relationship with pharmaceutical medications and what sort of ‘medication’ are we really seeking? Continue reading

Doctor Burnout. A World Wide Epidemic.

Burnout is the modern day pandemic affecting the medical profession. It is a condition that many of us are still in denial of. After all, it can’t be seen on a biopsy result or under an electron microscope, so how real can it be?!

Very real.

50-60% of doctors are burnt out, and the rates of burnout have increased over the last 10 years. It would be unlikely to consider that this is simply because there is greater awareness of the condition.

85% of medical students and junior doctors are reported to be burnt out.

This is staggering, and these results are across the board globally. Not just the USA and not just UK. These are overall global professional rates of burnout and the rates are deeply alarming.

Even if we had 30% of the profession suffering from burnout, this would still be a pandemic, yet there is not the global attention to this matter that it deserves.

If there was an outbreak of influenza or a critical disease globally that was wiping out even 5% of people and removing them from the work force, there would be a world wide inquiry.

Yet here we have matters where there are 50-60% rates of burnout, over half of the entire medical profession, and there is no world wide inquiry into what is going on in medicine.

Certainly there is no vaccine likely to be available, but the matter is critical.

Ought not the World Health Organisation be taking a key interest in this matter?

Ought there not be a global inquiry into the culture of medicine and the attitudes of medicine towards doctors and health care professionals? Continue reading

What is ‘care’ in Healthcare?

 

When we are trained as students, we are trained to present a ‘caring’ front to patients, to be seen to be ‘caring’ and to be ‘caring’. But we are not really taught what care is…. I recall being told to show sympathy and empathy to people in their situation, told to say ‘the right thing’ to express ‘concern’ which made me profoundly exhausted and did not hold the person I was with in equalness. But sympathy and empathy are not care. They are reactions to care.

The sort of people who do medicine are on the whole innately ‘caring’. It is a quality that we can all feel.

I recall the first day of medical school and the first years of medicine being so impressed at how interested my colleagues were in people, about understanding people and about caring for the people with illnesses and disease who came to visit us and teach us about health, illness and disease. They inspired me. I like many others found it quite overwhelming to see the vast extent of human suffering and distress, and did not know how to handle that with my deeply caring nature. I felt that I needed to be able to fix everyone and take away all of their suffering. That was a big burden to carry, and one that I know many doctors do.

I then watched many of these same caring people, who were so interested in people, move away from people oriented professions in medicine, seemingly suffering ‘caring’ or ‘compassion’ fatigue, finding it overwhelming to spend so much time with sick people.

I have spoken to several colleagues and read many shared stories where people have either left medicine for ‘survival’ reasons, or chosen professions where there is less contact and less ongoing ‘care’ for people as a survival thing. It is well known that the burnout rate is far less in professions where there is less ‘patient’ contact.

This is disturbing and a shame, because medicine is about people, and if we cannot be with people without getting exhausted or overwhelmed then there is a real issue.

If we are not taught how to be with people in a way that does not exhaust or overwhelm us, given that everything about medicine is about people, then we are missing something fundamental in our medical training.
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Why do we make education hard?

I spent a LOT of time in education. I have spent a LOT of time reading books trying to learn things. I studied medicine, which is lifelong and ongoing study. I’m still studying, all of the time in fact!

The language that is used in education is extremely complicated. We are taught with complex words delivered in complex and uninspiring ways. I have spent countless decades trying to survive, yes survive the most tedious and boring lectures and I know I am not alone here.

Who decided we needed to make learning boring and hard?

At what point does learning stop becoming fun and interesting and becomes some onerous boring chore of a task?

When we are small, we enjoy learning. It is a joy to learn new things about life and the world. Learning is made fun. We have fun learning new things, like…. walking, where the parks are, what animals are, and what our foot tastes like when we put it in our mouth…..

Adults do their best to support kids to learn. Toys are designed to make learning ‘fun’ for children. Things are kept simple.

But for adults? Is learning made fun? Even in high school?

At what age is it ‘right’ and decided to take the fun out of learning? Continue reading

Medicine in the age of technology. Does the personal matter?

There is much talk about ways we can reduce the costs of health care and to ‘streamline’ health care. There are some conversations that are happening about people putting symptoms into machines to generate diagnoses and then generate a treatment algorithm instead of seeing a doctor. This would of course make the cost of health care cheaper by eliminating the role of the physician, but is this really the best practice of medicine?

Can computers and algorithms really replace the role of doctor, or even nurse?

Even if it would reduce ‘costs’ by eliminating the personal contact in medicine, is this really the way forward in medicine?

Would it offer better patient ‘care’?

Would it even offer better patient ‘diagnosis’?

Many patients come to see me having put their symptoms in a symptom checker online only to be freaked out by the potential of multiple serious diagnoses, only to then find when they see me that they have something quite simple and nowhere near as severe as the symptom checkers had lead them to believe.

It takes skill, connection and experience to diagnose what is happening in a person as no two people have the same presentation of an illness and disease.
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Competition in Medicine. Who does it serve?

To get into medical school we learn that we need to ‘compete’ with others, that ‘competition is fierce’ in order to get into medical school, and ‘being ‘competitive’ is seen as being a very good thing.

But is this really a trait that is desirable in a physician?!

Being a physician is about being with people. It is about dealing with people, it is about caring for people – it is not about competing with people!

So why is medical school set up in such a way to foster and encourage competitiveness from a young age?

Do we really need to inspire this sense of ‘competition’ in people so that they will learn and do well?

Do we need to inspire people to try and ‘do better’ and ‘be better’ and beat others irrespective of the topics at hand?

Do we assume that people will be too lazy to learn or pay attention unless they need to beat others?!

And moreover what does this mean when these particular traits and characteristics are carried over into medical school and then into physician life once one has graduated and entered the treadmill of life? Continue reading

How at risk of suicide is your doctor?

Did you know that doctors have 2-4 times the risk of suicide as the general population? With the highest rates of burnout than any other professional group? 85% of students and 50-60% of doctors.

That’s right, your health care professional is up to 4 times more likely than you to commit suicide.

How is it that our health care practitioners are so distressed that they not only want to but actually follow through and kill themselves?

When you consider the sort of people who start medicine are truly and deeply caring, what goes wrong? What happens?

Do people start out medicine wanting to kill themselves and that’s why they choose medicine?

Surely not……!

Or is the health care system so abusive towards those in medicine that the inordinate amounts of stresses and strains create isolation and distress and pressure that leads to self harming and self destructive behaviour and ultimately the final act, of removing ones self from life?

Much has been written on this subject. People are supposedly ‘unclear’ about why it is that our health care professionals are killing themselves, tending to blame the characteristics of the sort of people who choose medicine for not ‘stacking up’ to the pressure of everything that is entailed in medicine.

Women in medicine are particularly at risk of suicide, at a 4 times higher rate than the general population.

Its easy to victim blame, and to say ‘oh they couldn’t cope’ or ‘oh they were too sensitive’, but instead of victim blaming, perhaps we ought to look at the system that these people are placed in. Continue reading

The Silence of the Profession

Many of us in Australia will remember an ad for toothpaste in the 1990s where a man (with a great toned and tanned upper torso mind you) has his back to us whilst he is facing the mirror brushing his teeth. We are told they can’t show us his face, because he is a dentist. Apart from learning about this particular brand of toothpaste (?!) we learn from this that medical professionals are not allowed to be seen in public.

For me this is a great adage of the medical profession where there is some strange notion that we should be neither seen nor heard, and this extends to many in the profession who feel constrained to be seen as a person in public, or to have and voice their opinion in public for fear of being hauled before the medical board, or having their reputation as a doctor undermined or destroyed.

Many doctors will not be on social media, have blog sites or websites, and do not want to have themselves in the public eye, lest something ‘go wrong’ and their reputations be destroyed.

But lets consider this.

Does this even make sense?

Why is it that we would feel that being seen as the person that we are would possibly get in the way of people respecting us professionally. And why do we seek so much to separate the two? Are we really such a Jekkyl and Hyde? Are we one person at work and then some strange demonic being in our private lives that we would not want anyone to know about? Surely not… Continue reading

Doctor, who do you think you are?!

Are we the ‘role’ of ‘doctor’? Are we ‘the white coat’? Are we the ‘caring physician’, the ‘selfless physician’, the ‘exhausted surgeon’, the ‘busy GP’, the ‘doctor who can’t go on’? or is there something more to us than the world sees or trains us to be?

Now that’s a question that’s not in our final medical school exams, or our specialist exams! That’s not one that our patients ask of us either.

But actually, why not? Is not who we are within the foundation of everything that we do? Is not that our humanity, which is utterly vital when working in a caring profession that has care for humanity and connection with people at its heart.

And if we don’t know who we are at the end of our training, then what purpose has our training served us in truth, and the people that we serve? Continue reading