When I was in college, I majored in biology and thought many times about applying to medical school. I wanted to be a sports medicine doctor. But I fell into what was probably the deepest period of depression my senior year and nearly didn’t finish my last semester. There were times I was having trouble even walking, the depression was so bad. I decided not to apply to medical school because I felt that I did not have a support system and that I needed at least a minimal one in order to get through such a strenuous time. I also worried about having enough energy to operate on no sleep as required in residency. In my mid-twenties, I thought once again about applying, but never did. The death of my brother at that time sent me into another very deep depression. As the years go on, I am increasing glad that I chose not to go down that path.
In this well written and researched article, Meghan O’Rourke recounts her very long and frustrating experience with the medical community in trying to learn what was causing her chronic symptoms (not unlike my own), and learns that doctors are also becoming just as disillusioned with the system as told in several newly published books on the subject.
She writes, “In 1973, 85 percent of physicians said they had no doubts about their career choice. In 2008, only 6 percent “described their morale as positive,” … Doctors today are more likely to kill themselves than are members of any other professional group.”
6 percent?! I feel even better about my decision after reading that statistic. Not only are patients becoming increasingly more angry about the lack of compassion and care they are receiving, doctors are becoming more and more frustrated about the limitations imposed on them by insurance companies and system bureaucracy.
To me, the most striking part of this article was this: “Yet empathy is anything but a frill: not only is it crucial to doctors’ humanity and patients’ dignity, it can be key to medical efficacy. The rate of severe diabetes complications in patients of doctors who rate high on a standard empathy scale, Ofri notes, is a remarkable 40 percent lower than in patients with low-empathy doctors. “This is comparable,” she points out, “to the benefits seen with the most intensive medical therapy for diabetes.”
Compassion is not an option. It is a critical and necessary component of healing. We need to be nurtured in order to heal. I remember my overnight experience in the hospital following the breaking and moving of both my lower and upper jaws very well. (I could write an entire story about the botching of my care, the miscommunication between my surgeon and orthodontist, the being neglected by both of them, the subsequent and continued sinus infection as a result of a mistake during the surgery, along with other complications, the constant fighting with the insurance company…), but what I remember most was the lack of touch I received from the various nurses during my stay. Not ONE of them even placed their hands on my shoulders or body in a gesture of comfort the entire time I was there. My jaw bones had been sawed open, I could not eat and I had trouble breathing. The only thing I wanted was to be gently touched. Touching has been proven to heal people. I had thought (expected, even) that nurses, at least, were compassionate. Instead, they came into my room at all hours of the night, not allowing me to rest for long, always making me swallow more medicine or taking more tests, and then quickly exiting to check on another patient.
The one immediate change that I believe could be made in every medical situation is the component of compassion. Lack of time not be a justification. There is always time to look a person in the eye, place a hand on their shoulder or hand, tell them you are very sorry for their suffering, and tell them that you promise you will do what you can to help them. Compassion is a two-way street. It feels just as good to give as it does to receive. It benefits all participants.
For those who don’t have the time to read the full article, I have posted a few passages below.
“Doctors Tell All—and It’s Bad
A crop of books by disillusioned physicians reveals a corrosive doctor-patient relationship at the heart of our health-care crisis.”
by Meghan O’Rourke
For someone in her 30s, I’ve spent a lot of time in doctors’ offices and hospitals, shivering on exam tables in my open-to-the-front gown, recording my medical history on multiple forms, having enough blood drawn in little glass tubes to satisfy a thirsty vampire. In my early 20s, I contracted a disease that doctors were unable to identify for years—in fact, for about a decade they thought nothing was wrong with me—but that nonetheless led to multiple complications, requiring a succession of surgeries, emergency-room visits, and ultimately (when tests finally showed something was wrong) trips to specialists for MRIs and lots more testing. During the time I was ill and undiagnosed, I was also in and out of the hospital with my mother, who was being treated for metastatic cancer and was admitted twice in her final weeks.
As a patient and the daughter of a patient, I was amazed by how precise surgery had become and how fast healing could be. I was struck, too, by how kind many of the nurses were; how smart and involved some of the doctors we met were. But I was also startled by the profound discomfort I always felt in hospitals. Physicians at times were brusque and even hostile to us (or was I imagining it?). The lighting was harsh, the food terrible, the rooms loud. Weren’t people trying to heal? That didn’t matter. What mattered was the whole busy apparatus of care—the beeping monitors and the hourly check-ins and the forced wakings, the elaborate (and frequently futile) interventions painstakingly performed on the terminally ill. In the hospital, I always felt like Alice at the Mad Hatter’s tea party: I had woken up in a world that seemed utterly logical to its inhabitants, but quite mad to me.
In my own case, it took doctors a long time (roughly 15 years) to recognize exactly what was wrong with me. Along the way, my blood work was at times a little off, or my inflammation markers and white-blood-cell counts were slightly elevated, but nothing seemed definitive, other than some persistent anemia. “Everything’s probably okay,” the doctors would say, or “You have an idiopathic problem,” which is doctor-talk for “We don’t know why you suddenly have hives every day.”
To them, I was a relatively fit, often high-functioning young woman who had a long list of “small” complaints that only occasionally swelled into an acute problem, for which a quick surgical fix was offered (but no reflection on what might be causing it). To me, my life was slowly dissolving into near-constant discomfort and sometimes frightening pain—and terror at losing control. I didn’t know how to speak to the doctors with the words that would get them, as I thought of it, “on my side.” I steeled myself before appointments, vowing not to leave until I had some answers—yet I never managed to ask even half my questions. “You’re fine. We can’t find anything wrong,” more than one doctor said. Or, unforgettably, “You’re probably just tired from having your period.”
In fact, something was very wrong. In the spring of 2012, a sympathetic doctor figured out that I had an autoimmune disease no one had tested me for. And then, one crisp fall afternoon last year, I learned that I had Lyme disease.
But this essay isn’t about how I was right and my doctors were wrong. It’s about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.
Without being fully aware of it, what I really wanted all along was a doctor trained in a different system, who understood that a conversation was as important as a prescription; a doctor to whom healing mattered as much as state-of-the-art surgery did.