I am going to stray a little from my fashion coverage, the first time for over a week and a half now, but I am getting back to my original blogging plan of fashion, social commentary, and academics.
So, interesting piece in the times today about difficult physicians When The Doctor Is In, But You Wish He Wasn’t The piece speaks directly to the research I do at the University of Chicago Hospitals. I am working on the finishing touches to a piece on which I am a coauthor about the doctor patient relationship as perceived by medical students when coping with ethical medical decision making. The results of the study I have to say are somewhat disheartening to me. We took a sample of first year medical students and their responses to their final exams in their first Doctor-Patient Relationship course. We had initially hoped to analyze their ethically reasoning in relating to patients and difficult circumstances but so far I have found students to be prescriptive in their thinking, hesitant to engage in real dialogue about the nature of patients and their dilemmas, and generally nervous about making any judgments about the moral and ethical impact of a situation. In other words they just want to be doctors that say what is wrong, fix it, and would rather not engage with the issues too much. Dangerous ideals in ethically unstable times when we as a society have no answers to end of life and abortion issues. We found the doctors would simply rather take whatever they saw in the textbook and leave it at that. I think this article in the Times speaks well to this growing trend of diminishing interactivity between doctor and patient. The next step obviously is to discover why this is. My own personal thoughts are that medical students are lacking in their analytical skills for fundamental topics in moral and ethical realm. They are create at synthesizing chemicals but not so great at being sympathetic. But then college education so rarely forces you to deal with moral issues because we as a society would rather leave them alone. But sickness is a moral issue, it touches the core of our own values and beliefs and simply treating illness as a random event only casually related through symptoms and triggers ignores the very real narrative of illness for patients which I would contend is just as real and important as the disease itself.
I remember a few months ago an incident I had with two older medical students. I was coming back from lunch when the two students started discussing behind me how bogus they thought their doctor patient relationship course is and what a waste of time it was for them. One student said “My prof got pissed at me for not acting like I really cared about the patient substitutes, like I was only going through the motion, and I was like yeah it wasn’t a real patient! Why should I care about it? I mean when I have to take my exams then I will really pretend to care, but until then why should I bother? I mean if I can’t pass my exam I can’t be a doctor so I will fake it then but I won’t bother with this patient substitute crap.” Now medical students practice their bedside manner with actors. These students thought it was bogus they should practice and that they would fake it when they needed to pass their exams. The callous way they discussed the subject really frightened me so I told them “When it is a real patient and you have never practiced compassionate regard or nonjudgement or even basic curtsey then how are you going to feel? Now it isn’t a real person but one day it will be and I don’t with the attitude you have now things will be any different.” Well the students told me to screw off and that I didn’t know a damn thing about medical school or medical ethics and it didn’t matter because they weren’t real patients. Well I would say that it does matter, that you need to be trained to be compassionate because there are going to be rough days where unless you practiced staying in your compassionate stance you are just going to want to ignore the patient and you can’t do that. Doctors don’t have a lot of freedoms, they give those up in order to serve. Now mind you these were students at a hospital renowned for superior medical ethics training. It gets you thinking though? If they can’t be bothered in medical school to practice I don’t think there is going to be any guarantee that they will always be on their game later in life.
Triage
Yes but since most doctors aren’t triage doctors I think manners are a tad bit more important
I agree, manners are extremely important in a doctor (or in a nurse, or assistant or any health practitioner). I’ve met many doctors who probably thought they were being great to me, but who actually were frustrating or insulting or condescending. I think that classes in bedside manner are important for doctors and should never be blown off by any good doctor. I hope that the measures being taken to try and improve doctor/patient interactions are great and I hope that they succeed! Thanks for the link and the interesting input!