My Forgotten Goal of Medicine
An attending told us today in our first psych lecture, “Medicine is not about stamping out disease, it’s about helping people.”
Boy have the days of medical school applications passed.
No longer do I try to figure out how to rephrase “I want to help people,” and fit it into a 500-word essay. But along with it went the whole initial notion of medicine–that is, a profession built on helping people, improving lives, easing suffering. Now for me it’s about turning a patient’s story, signs, and symptoms into a diagnosis, and then figuring out what to do for that diagnosis. Sure, often the goals overlap–but in the end, I’m not out to relieve suffering, I’m out to cure disease.
I expect (or hope?) that this will come back to me once I get the whole “diagnosing and treating” thing down pat–hell, a large part of the reason I write this blog is to remind me and others of the important stuff, because it’s just so damn easy to forget.
I guess the attending’s thoughts will help you in those times when there’s no “stamping” to be had. It’s then that you need to turn on the “helping people” part, and perhaps your only role will be to comfort….which is not something they can teach you in any psych class.
But for now…work on the stamping…it’s a good goal, me thinks.
I think its both hard to learn and easy to forget. The conscious that used to guide me sometimes gets buried under the pathology.
Graham,
It’ll get easier when you “take it to the next level”, i.e., when you start developing managment plans. You might even experiment with taking it to the next level now. Why wait until fourth year?
The “P” in SOAP is a lot closer to ‘helping people’ than the ‘A’.
best,
Flea
It becomes (often painfully obvious) later on. I feel like I do very little disease treatng some days.
I thought medicine was about maximizing the profitability of insurance companies, managed care companies, and pharmaceutical companies while continually increasing the compensation of all their Executive Teams.
Or are you perhaps referring to what passes for medicine in other countries that are less advanced than the United States?
Sometimes the hardest thing to realise is that the worry that there isn’t much time is the thing getting in the way. The trick to helping people is conquering any doubts and just doing it (I don’t mean medically because then I’m guessing the doubts would be valid). You can’t help others until you can get past the self; and helping doesn’t even mean you have to do anything overly much, in most cases its just sending them in the right direction.
You may just have hit the Med/Surg divide. As someone pointed out to me the other day, apart from infections, there are very few things, as a physician, that you can definitively say you have cured in a patient. It’s mostly minimising the progress of disease or its manifestations.. But no matter what you do, if you remember that there’s a person behind that pathology, it’ll turn out better..
“treating people” is something that you’ll come back to as a foundation once the huge info/training onslaught is absorbed a bit. Keep it as a goal for now, but focus energy on what needs to be done now to get there. Compassion will always be at the base of the therapudic relationship, and will not be swept away. Buried for a while, maybe!
also, did anyone else take folklore in college? It is a great way to recognize patterns and variations. VERY helpful for h+p, and sorting stories and info. (dx, etc mentioned above)
thinking on ya, and everyone in the training phases
Shel
As Tyler Durden once said, “On a long enough timeline, everyone’s survival rate drops to zero.” Most of medicine is either delaying the inevitable (because if you aren’t going to die from heart disease, you’re going to die from cancer, or if you’re unlucky, from a car crash), or waiting for the inevitable (because sometimes all you have to do is keep them hydrated, and their fever or respiratory infection or diarrhea will go away on its own.) Even the knifemen can only do so much (although, granted, they are much more definitive about it than us pill-pushers.) All surgery has complications, and just when you think that appendectomy 40 years ago is completely irrelevant, some guy is going to come in with a bowel obstruction that has no other obvious etiology, and at least 50% of drug-seekers are people who have undergone multiple back, knee, hip, or limb surgeries. But I digress. No matter what level of knowledge you have, from med student to super-sub-subspecialist, sometimes the most valuable thing you can offer is hope, and trust. And sometimes that’s all the patient is really looking for.
I highly recommend seeing the film Wit, directed by Mike Nichols. It sort of addresses this concept of how doctors view their patients. In the film, the main character, played by Emma Thompson, is dying of cervical cancer and opts to become part of a clinical trial for the development of a drug that will not be able to save her life but her participation may help save others in the future. The woman’s diagnosis is grim-she is sure to die from this cancer. So, the question is how do doctors deal with patients whose likelihood of being saved is highly improbable. One insensitive intern, whose ambition is to become a doctor involved in research, merely views the woman as a lab rat whom he is only interested in using as a means of discovering a new drug. He has no interest in helping her or making her feel less pain. This film is must for all doctors and aspiring doctors to see. Doctors need to be aware of the danger of looking at patients as bodies that contain diseases they wish to find because no body wants a doctor who views their patients as some sort of game or code they are trying to solve-I know I sure wouldn’t. So, once again, the title of the film is Wit and it is directed by Mike Nichols. This film should be a requirement for all medical ethics classes-yes, it is that important.
Graham,
It depends on your definition of “curing disease.” If that is your real goal, then you need to go into research. As has been pointed out by several of those who have commented on your “post” most of the time physicians can’t “cure disease.” Compared to what we could do for patients when I was in medical school, your generation is light years ahead. My first surgical case in private practice was to biopsy a lesion in the femur of a 19 yr old young woman. The biopsy revealed osteogenic sarcoma. There was only a 10% chance that she would survive and she did not. Today that same patient would have a 70-75% chance of survival.
Children who once died of leukemia can now be cured in many cases. So you can cure disease. When you see a patient, take the history and do the physical exam, and then order the appropriate lab tests, you are not only trying to cure disease but at the same time you are helping the patient. Why should there be a dichotomy in your thinking when you say you are not out to relieve suffering but rather out to cure disease. I believe the two are inextricably intertwined. In those cases, and there will be many, you won’t be able to “cure” the disease, but by listening to the patient and in trying to relieve the suffering you may well be offering that patient a form of a “cure.”
When I would reduce a fracture and follow the patient to the point of seeing the fracture heal I in essence saw a cure. But all I did was to put the bones in a position so they could heal.
When an internist controls a patients hypertension he/she has not cured the patient but the patient has a far greater chance to live out a normal life span than the hypertensive whom I may have seen as a medical student.
shel put it very nicely.
Whether it be curing an illness, relieving a symptom, or palliating a patient – the aim is always to do something positive for them. In that sense the emphasis is not so much on the disease process, but how that disease process affects their life, and how we as doctors can change that in some way. This is especially important when dealing with the other support staff in the hospital – often people like social workers can do just as much for the patient as doctors can. At the end of the day, it is whether the patient feels their life has improved that counts.