At a medical conference, for doctors, at the end of last year, we were informed in one talk that:
- Doctors don’t like treating patients
- They don’t have time for it
- They don’t do it well, and not only that
- They are not interested in doing it well
Needless to say as a person who loves medicine and people I was somewhat stunned (and I must confess, moderately incensed!) to be told from the pulpit so to speak, how I do and feel about my job from someone who has never met me or spent time in my clinic. And I am not alone in this response and feeling given the conversations I had with others who were in the same room as me when this invective was unleashed.
I heartily disagree with the statements that were presented to us. I personally feel they are coming from a burnt out jaded perspective, from someone who has given up on medicine and people in medicine. But this is not the first time I have been apprised of such attitudes in medicine. I have read papers that have said that doctors ought to have their attention focused on diagnosis only, rather than the day to day treatment of patients. And I have had conversations with peers who also feel that is where we need to have our attentions focused. Some people are proposing that doctors ought to ‘just diagnose’ and ‘other people’ ought to do the treating, following protocols, such as nurses.
It concerns me deeply to hear such perspectives gaining momentum and I am concerned for the future of health care and medicine.
Medicine is about people.
People are the heart of medicine.
Medicine is all about people. This means taking the time to see and speak with people is part of medicine. Medicine is not about facts, figures, diagnoses and protocols.
At its heart, it is about deeply caring for people.
If we eliminate connection with and care of people from medicine, and eliminate that from our role as medical professionals, then what sort of a profession do we have? Of what service is it in truth?
And will it work anyway……
Continuity of care is vital for the learning in medicine as well as for the people that we are seeing. There is much that we learn from our daily interactions with our patients. Those of us in full time patient care know how well that people do not fit into diagnostic boxes easily, treatment algorithms do not apply to easily to the person in your consulting room, and people have many variables about how they personally feel their health care needs to be addressed.
And, we all know that people do not respond to treatments the way that algorithms and protocols would like them to…
It takes the skill of a great physician to learn from people and to be able to truly tailor treatment to each individual. This comes from life experiences, each patient interaction, and not just from text books. And this is something that we master in time. I have learned with joy from experienced physicians in my life, who have imparted far more to me from their cumulated life experience that what I have learned in any text book.
People and diseases and states of ill health are always changing, and each person has a unique configuration that needs personalised attention. This is the joy of medicine, and the art of medicine. It comes from connection with people and care for people and the willingness to observe and learn from what is happening with each person, to work with each person, rather than trying to make each person ‘fit in’ to a protocol box.
If we do not have day to day experience with people, then how will we learn and be able to ‘diagnose’ as people have suggested that our role ought to be?
We won’t be able to do even that.
Much of the ability to diagnose well comes from the day to day learning from the health experiences of the people that we see as well as the collective case experiences of our peers. It does not come from text books or journals.
If we do not see people and learn from how they respond to treatments – or not – then we will not even be able to do the diagnosing that we are told that we need to do!
People are the heart of medicine. It is vital that we do not eliminate people from medicine and that includes us as medical professionals. Approaches such as those recommended at the conference eliminate inter-personal connection and relationships from the health care profession, and with that approach we will all be worse off.
We will no longer be leaders in health care, as we will no longer be caring for people.
Care leads the profession, not knowledge.
We bring so much more to our patient interactions than the knowledge that we know. We bring with us a wisdom, a true care and connection that brings more to each person. We learn and grow from each interaction as do our patients. And with every learning our wisdom grows so that the next person seeing us stands to benefit even more.
The deepening of our relationships with our patients over time is key and perhaps something that we don’t take the time to value and appreciate enough in medicine.
Our patients are touched by our care, not just our knowledge.
There is more to healing and health care than knowledge and this is part of the power of relationships in medicine.
In reference to medicine Hippocrates said:
‘Life is short, art is long’
If we remove ourselves from people and keep ourselves strictly related to knowledge, we will not master the art and medicine will be lost.
Treating our patients is a vital part of the art of medicine. If we do not take the time to treat our patients, and do not enjoy the relationships that we have with our patients, then what profession are we in? Because it is no longer medicine.
And then who will lead health care?
Health insurer funds? Government? or other companies with vested financial interests?
Who will lead the way? And will their motivation be a true care for all people, or profit and ‘economic efficiency’? And where will this leave us all in health care…
It is care before profit in the true practice of medicine and in that we as physicians must lead the way. And we cannot do that if we do not take the time to treat our patients.
I’m interested to hear from you. As doctors, do we see our role as only in diagnosing? How do we see ourselves in medicine? And as patients how would we feel to see a doctor to come in only to diagnose and then hand over the ‘treating’ to someone else never to be seen again? Would we feel complete in our health care?