One of the first lessons a physician gets in caring for patients is the virtue of objectivity. “Doctors can’t afford to be too close to their patients.” They pound this into our heads. “It will cloud your clinical judgement.” “You will burn out.” “Your problems are not their problems.”
Something about that always seemed a little off with me. What doctor goes into medicine with NO expectation of knowing, connecting with and helping patients?
They claim it central to becoming a clinician. While critical thinking, pattern recognition and problem solving are central to the science of medicine, taken alone they neglect its soul. Can we practice medicine out of balance and still meet the needs of patients? We may become good at curing, but we completely neglect healing.
I understand the idea, say, in the case of a surgeon. They function essentially as mechanics or technicians. It is somewhat difficult and distracting to actually cut into your best friend. The emotions and the racing thoughts would not be helpful for the task at hand. Certainly, singleness of mind is what you look for in a heart or brain surgeon. Surgeons are all about curing, not healing. They get in, get the job done, and get out. Undoubtedly this mindset has its place and certainly, many, many physicians have found this their place to make a great mark on the world.
But this is much different than healing. Dr. Rachel Remen, in a highly recommended speaking of faith podcast describes her experience of what objectivity does to a doctor. As we buy into the idea that the loss others experience is not our problem, we are lying to ourselves. It does affect us. We hold within ourselves sadness and give it no outlet. The burden becomes heavier, not lighter. Sharing grief with others can lighten the load. I think one of the absolute most important things any physician can do is to attend the funerals of their patients. However, if your entire goal in life is to prevent death, than this becomes a frightening proposition. You are staring the failure of your life’s purpose right in the face at a funeral. Sadly, doctors have to face the realization that life has a 100% mortality, even if we wear out our own lives fighting it.
I have found that bottling pain in leads to some sick outlets. Doctors can laugh and joke about some of the most painful, horrible situations. It is a cynical, distancing laugh. It is a laugh born in a feeling of powerlessness. It is very twisted and dark. Like all laughter, it is born in pain. However, unlike typical laughter, the best medicine, It’s cynical nature poisons the wound. I have found this is a route to joylessness and burnout in the pursuit of medicine.
Additionally, patients and family dealing with serious emotional issues have very raw nerves. They have a justified, palpable anger which often attaches itself to the first available target, ourselves. When this happens you have to fight it, hard. How can we overcome the instinct of defensiveness? I have not always been as successful at this as I would like to have been. Many a doctor-patient-family relationship has become irreparably broken this way. I have seen it lead to law suits, remove doctors from practice, and cause assaults, death threats from patients.
Healing is something different. When we can cry with our patients, when we allow ourselves to feel their pain, we make a very deep and important connection. It hurts, yes, but then we move on. Both we and they heal because we both feel and understand the other. This is my goal as a physician. I have been more successful with it at some times than others. When overworked or awakened at 3am I have struggled as my strength was stretched to a breaking point. But when it works, I gain a glimpse into to resilience and wonder of humanity. I regain my soul.