Timely Lessons on Humanity and Professionalism

2008
Stewart, Brad

It surprises me sometimes how adaptable the human mind is, but how slowly sometimes we get to a new point of equilibrium and even contentment with change. Here I find myself with four months left in medical school and I have finally come to accept and embrace the changes that come with being a medical professional. That is as it should be, since on May 23rd I will become a physician, albeit one who is embarking on the residency journey.

The changes in professional attitude come at many levels, from the superficial to the profound. The process of applying to residency has forced me to look inward - as I wrote and rewrote the many personal letters, one each for seven universities representing nine programs, my words changed from banal pandering to the checkbox requirements of explaining “why you want to be a family physician” and “where you want to practice medicine,” to gradually become reflections of my growing introspection.

Superficially, I have come to accept that once again in my professional career, and at least for the next couple of years, I am not the master of my own domain, that I am in thrall to a system whose ultimate purpose is to make me ingest so much knowledge that, if I don’t burst first, I should then be able to integrate, digest, and deploy it in my patients’ best interests. Superficially, I have learned to accept that I am a relatively intelligent individual who has grown to have a good systems understanding of many of the biological and psychological processes that interact to provide the human body with health and, yes, to subject it to illness.

But, more profoundly, I have come to understand the terrible responsibility that comes with applying this knowledge to real, thinking, human beings. Certainly, tritely, I was willing to accept this responsibility when I applied to medical school, but my understanding was only vaguely representative of the reality. Where I was already willing before, I am now ready to accept it. And that is well, because I have come to learn that, even as a medical student, one needs to understand the immensity of the responsibility to properly accept it.

I thought that I understood people well enough before becoming a medical professional, not in the way of an arrogant declaration of omniscience, but as a perhaps too-casual belief that my several decades on this planet have counted for some wisdom about people. I have learned in the last two and half years not only how right I can be about people but how utterly little I understood them, and perhaps still do. I am glad that I have come to this realization, because even though I hold that I remain a good student, but not a scholar, about human beings, they constantly amaze me. It amazes me how some of us can endure tremendous hurt without suffering, but how there are others who can suffer dearly with little apparent illness. The interaction between the human mind, the sense of self, spirituality, and the biological reality of a human body programmed ultimately to wear itself out and die, is truly a wondrous thing.

I deal with patients somewhat differently now. I have always respected them, but I now understand more the amount of trust they put in physicians, some of it unfortunately misplaced, and how precious this trust is. It’s easy to say this, and it makes a great throw-away phrase for residency applications, but to become a more than adequate physician I believe that I have to totally buy into the concept. It means that the supercilious stinking drunk patient arriving in the ER in the wee hours of the morning always deserves a second chance at breaking though the barrier of disgust, for example, since he’s there because he trusts me.

To me, the truly great physicians are those who get it. The last two weeks of December I was doing an elective with a urologist, which saw me spend lots of time in his back pocket. Enough time to realize that some of the nurses saw him as an abrasive perfectionist who sometimes rubbed them the wrong way. He was all of that. He also understands trust and the vulnerability of patients. As one example, I was busy assisting him doing a urethroscopy of a middle-aged woman’s bladder who was complaining of acute on chronic gross hematuria (large amount of blood in her urine). After he inserted the scope, I remarked what looked just like a beautiful giant coral waving in the ocean currents, but turned out to be frank transitional cell carcinoma invading over 50% of her bladder wall. The care with which he described the problem to her, the prospective treatment, and the potential outcomes, some of which were not very palatable, all the while gauging the vary vulnerable patient’s mood and comprehension, was touching.
He gets it.

Theme: Health Care Delivery | Prestation des soins de santé
Theme: Physicians | Médecins
Theme: Teaching and Learning | Enseignement et apprentissage

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.

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