The first week of Paediatrics was packed with lectures and presentations. Chapters and endless pages of literature topic by topic all squeezed into one or two hours at a time. I think it's rather humorous that Clinicians emphasise oh so very much the importance of evidence-based practice and yet, we are still using traditional didactic teaching methods with some additional fancy gadgets compared to a few decades ago... all of which arguably have little evidence in the context of educational efficacy. But hey, that's why we have clinical attachments for the next three weeks - where each week we'll all be in different departments. Just when we get the hang of where to show up at what time, the names of all the staff members and our second chat with the consultant that involved being asked questions we couldn't answer, we will be off to experience the disorientation again in another department. Charming!
But I don't really mind. I just enjoy predicting how miserable I'll be in six weeks from now. So on our first day back, I was curious about how people might have changed after their elective term. How did their experiences affect them? Are they affected at all? I pondered all the way to the wrong train station, then all the way back to another train station and then back on the wrong train again. I showed up at 1045 when we started at 0830. I don't think I've ever been so late in my university years; at least not by mistake.
Morning tea time! Unheard of in my elective hospital and something I welcomed before our next couple of lectures on a Tuesday morning. I was talking to one of my colleagues, who is hell-bent on becoming a surgeon and already in the process of deciding which pathway he should take to become the sub-specialist he would like to become. I admire people who have already understood and appreciated their years ahead, but being so specific? I can't help but feel their insight must be restricted to what they've seen in the context they saw it.
I listened intently to his stories from New York, where he saw dozens of trauma cases, scrubbed into case after case learning techniques and getting down to the fundamental principle of Surgery: to save life in dire need. He was sure he wanted to become a Trauma Surgeon and from his list of credentials plus the scholarship he received to see what he did, I see him on the successful path to doing exactly what he wants to.
He passionately explained "procedures unknown to us in Australia" to save the lives of people who were in horrific accidents, victims of domestic violence and gang warfare. He described the unique procedures to me and yes I agree, they were quite radical and probably not performed in Australia routinely. And only a handful of people could perform them.
But throughout this encounter, he never explained anything about the patients except for their presentation to hospital. Typical surgeon I hear you say, but that's not true. Surgeons must still take an interest in their patients beyond their anatomical planes and site of haemorrhage. Patients are not just a list of potential complications, risk factors and mechanical defects... and to hear my colleague explain these patients and their management depressed me because I'm sure he didn't know a single one of their names.
So some of us are already falling into the trap of adapting personality and behavioural traits that will not make us good doctors. And this fine medical student, a distant colleague of mine, is well on the way of becoming what he always dreamed of... but I'm sure somewhere in those dreams he didn't consider the guilt of not providing reassurance, or empathy.
Perhaps the whole point of being a Trauma Surgeon is not to interact with people or obtain consent; the law has provided that for you - just ensure the patient is resuscitated so that they can form opinions again. Oh and if their opinions were not what was expected (i.e. instead of "thank you so much, God bless you, I'm alive" one is told "you couldn't spare two minutes to explain what you did; you told me to come back in two weeks to be seen again but I don't know why") - then maybe, just maybe, the principles and philosophies you (medical student) based your career on need revision.
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| The problem "is" choice. |
Hi, I have been reading your blog for some time now. Reading your thoughts, experiences and reflections has been a very thought provoking. I congratulate you on your success on becoming a good surgeon who tries to put his patients above anything else.
ReplyDeleteBut is getting to know your patient's names and their hobbies and letting them know exactly what is being or will be done to them all there is in empathy? Don't get me wrong all these things are most definitely important but if one does not do all that does that mean that they have no empathy?
Like you said being a surgeon often means that you have to act first ask questions later especially if you work in trauma. But I think being there and making the best medical decision on the patient's behalf and use all your skills in order to make them better does take a considerable amount of empathy on the surgeon's part don't you?
My mother's mentor, a renowned neurosurgeon in Mumbai said to us that being a surgeons often comes down to not being extremely empathetic. He said that he had performed hundreds of successful surgeries with utmost focus but if there was his daughter who was lying on the table his hand would not have stopped shaking.
Hi zed333,
DeleteI really enjoyed reading your comment and your questions could not have been more appropriate!
I think getting to know patients is an important part of their management, be it in medicine or surgery. Yes, of course we don't need to know what their hobbies to offer empathy... that was just an example and obviously not a very good one! I meant it metaphorically; we don't know who patients are... all we know is they have a defect (acute or chronic) that requires mechanical repair, resection, etc.
My main concern is surgeons these days potentially care about the procedures they perform, though they scarcely concern themselves with what it means (to patients and families) to perform it. In the context of trauma, you're not in any position to consent anybody or to explain anything - "shoot first, ask questions later" is the correct and most appropriate response here. However, my point there was referring to the post-operative care; does the patient know what just happened, why they were operated on and what things were happening?
Utilising skills in the operating room is paramount and it is where empathy must be left within the patient's mind with reassurance until they slip into their unconsciousness in the hands of the Anaesthesiologist. It is then, empathy must be put aside and the focus priority is the technical skills required to complete the operation with the minimum complications.
Surgery is not only about tissue repair. At some point, you'll need to discharge your patient and you must know where you're discharging them. One must consider the big-picture: the patient is not defined by their surgical problem and there are a lot of psycho-social components to management prior to discharge from hospital.
I agree with your mother's mentor, but you must recognise this as a coping mechanism in order for surgeons to perform their work. However, we should not abandon the holistic perspective because it's easier for us to focus. The real challenge of being a surgeon is to be an all-rounder. Otherwise, there is no difference between a surgeon and a technician.
Oh and taking care of people related or close to you is an absolute no no in medicine.
I hope I was able to clarify my entry!
Hi Endless,
ReplyDeleteYes, I see your point clearly now... I had the impression that you get upset or depressed if you notice that a doctor and his/her patient are not the bestest friends in the whole world.
But yes, you do raise a valid point of surgeons only caring about the procedure at hand and not the post op care and support that the patient needs. Performing a procedure and then Ta Ta is not an indication of an empathetic surgeon.
"The real challenge of being a surgeon is to be an all-rounder. Otherwise, there is no difference between a surgeon and a technician."
Well said. (Can steal this quote? Seems very useful for future essay preparation in something that starts with G and ends with a T).
"Oh and taking care of people related or close to you is an absolute no no in medicine."
What? Why not? There is no conflict of interest here...
Anyway... GL for your graduation...
You're more than welcome to steal this quote. It's actually not incorrect. In English history (I'm not sure of the century), Physicians did not operate on patients and asked barbers to do so as it was thought barbers would be more skilful with the instruments.
ReplyDeleteThis is why if you look at the title of an English Surgeon, it should be "Mr." or "Ms." rather than "Dr." - an interesting reminder where Surgeons come from and not something to be completely proud of; because it shows that people with no medical insight could actually be technically competent and therefore there has to be some differentiating factors.
Regarding family, there's a large conflict of interest. It's almost impossible to see your relatives' presenting complaint in an objective perspective. One is less likely to take their problem seriously and dismiss it as a benign problem; I've witnessed consultants do this. And it's a big responsibility to take on board because if you do slip up, the guilt and potential sequelae with the rest of your family would be catastrophic. So if my family asks me for help, the most I'll do is provide an explanation and refer them to their General Practitioner, who has the best perspective. And it's up to them if they listen to me or not, but to perform investigations or prescribe management is not appropriate. I'm not sure if you would want that responsibility.
And technically, if you are "the best" at what you do, then of course you do what you have to and play your part. But if you aren't "the best" (i.e. 99.97% of doctors out there) - then you owe it not only to your relatives but also your patients to refer them to "the best". Wouldn't you agree?