In Medicine, we learn that life is about marks and doing work for patients. We are not taught to work together nor are we taught of the importance of working together in a collegiate manner. We are not taught to take care of ourselves or to take care of our colleagues. Too often there is open hate and hostility on display between doctors in hospitals and in private practice. Stress and tension run our relationships and very often judgement and condemnation of each other, whether vocalized or hidden, are the order of the day. In this day and age where the mental health of the profession is worse in many regards than that of the general public and suicide rates are higher than the general public, are our relationships with each other important in medicine?

I’ve been in Medicine now for over 20 years. One of the things that I have observed over the years is that our relationships with each other in Medicine are in general sadly not good. We are competitive. We work in isolation as a general rule. We don’t really support each other or ask for support, or allow support when it is on offer. We are the ones who are supposed to be ‘OK’. We learn to work with random people in teams in hospital and we keep the relationships ‘professional’ and consider them short term professional relationships that we have to ‘survive’! They are about work and they are about training. It is rare to develop relationships at work that are truly personal, ones where you feel truly safe where you can share and seek and give support and care that is non-judgmental. As doctors, we don’t let each other in, and we only share certain aspects of ourselves. We place huge expectations on ourselves and each other leaving little to no room for a true care.

In Medicine we learn that you have to be ‘tough to survive’. We learn to toughen up, and to not show any emotion. We pretend that we can ‘handle it all’. If we show that we are not able to ‘handle it’, then we learn that we are seen as defective, as a nuisance, and a problem who is not tough enough to handle it all. Those who are seen as weak in the profession are ostracized, eternally. I to this day remember a woman in my intern year who took a few days off ‘sick leave’ after a long stretch of days working, and was later seen down the street with her husband. She was judged within an inch of her life and complained about by many of the interns and she lost all credibility, forever. No care or concern was given towards her mental health and whether or not she was coping with the job or, whether she needed support. Support?! That thought never even entered our minds! The only focus was to judge her for not coming to work because she was clearly able to walk and to move and had not broken all 4 limbs.

And this is how it is in medicine. If you can breathe at least through one nostril, and stand up – at least on one leg, you must come to work no matter how you are feeling. There is no care and concern for how you are feeling. Mental and emotional health does not rate a mention. In retrospect, this woman was clearly struggling with the work and her life and she did the best thing she knew at the time to best support herself.  Looking back, she actually needed our support too! At the time she was judged and condemned as not being committed, as causing a strain on the rest of us who had to ‘pick up the slack’. And this is a common scenario in Medicine, more particularly in bigger institutions where people do not know one another. None of us took the time to consider the bigger picture, or to care for her health and well-being – as none of us took the time to take care of ourselves either. And how often does this happen in medicine when one part of the team is not doing well and the rest of the team instead of coming in to support and care simply judges and gets impatient? Continue reading →

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 →

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.
Continue reading →