Demystifying Medicine One Month at a Time

Tag: finding meaning in medicine

Med Men

Dick Whit–er,…Don Draper. Medical role model?

It’s never really discussed.

We don’t learn it in med school. There are opaque references to it in residency.

Once we’re out, it slowly becomes an unpleasant realization. We give it other names, and ascribe the motivation (or lack thereof) to others–our patients.

It’s selling.

Patients look to us for medical advice. It’s a vulnerable state to be in. A generation ago, we simply told you what to do. And you did it.

Now we practice “shared decision making,” and make recommendations to you that you are free to accept or reject.

The conversations are seldom on the level. Most of you don’t want to outright defy us. You risk our….wrath? Our disfavor? Our disappointment (always my parents’ strongest weapon).

When you don’t follow our recommendations, we call you non-compliant.

The newer, more politically correct term, is non-adherent. Sometimes we just say you’re a “bad patient.”

But doctors are really (M)ad Men (and of course, increasingly, women). We have to sell you our ideas, even when you’ve become increasingly knowledgable and justifiably more critical.

The truth is, selling is easy most of the time: We believe in what we’re offering–intellectually and emotionally–and some of our ideas are so commonplace (colon cancer screening, treatment of high blood pressure, etc.) that you are receptive to the ideas. It’s a win-win.

It gets a lot harder when we don’t necessarily believe in what we have to offer, or are outright skeptical of something that you ask for.

Communication is one of the ‘competencies‘ on which we evaluate trainees. It’s vitally important. But we don’t teach it or evaluate it well.

Here’s a powerful example, appealing to both our minds and hearts, and making the complicated simple and appreciable even by a child.

I wish for better, more straightforward communication amongst all of us.

Grand Rounds

Welcome to Grand Rounds, where writers, readers, and bloggers send in their best stuff on a weekly basis to share, cross-pollinate, and build new audiences.

Tip of the hat to Grand Rounds co-creator Nick Genes, MD, PhD, an ER doc in NYC who knows a thing or two about blogging, tweeting and now Tumblr.

a timeless and inspiring read...

The theme of this week’s Grand Rounds is “Finding Meaning in Medicine,” with full attribution to Dr. Rachel Naomi Remen, author of the masterful book Kitchen Table Wisdom: Stories that Heal. My wife and I had the privilege of meeting Dr. Remen in 2008, learning from her during a glorious week in Bolinas, California at the Institute for the Study of Health and Illness.

Dr. Remen is an expert at re-connecting health professionals with what brought us into medicine in the first place. I can think of no better Grand Rounds topic than asking bloggers to share their meaningful stories.

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Stories of Meaning

Starting off, I’m linking to a story from Zocalo Public Square by Ken Murray, a family doctor at USC. His piece titled “How Doctors Die” has gone viral, as evidenced by the fact that I’ve seen it linked, sent, and tweeted more than a dozen times in different media.

Murray’s piece raises big issues of Meaning: namely, the big one: the meaning of life, and a less big one: the meaning of medicine. I, too, wrote a piece like his a while back, expressing my view that most doctors would never wish to die in a hospital, and share it with you here so that you can compare. Feel free to tweet mine, too, if you find it worthy. It’s called “A Good Death.”

Ed Pullen, a family doctor from Puyallup, WA, sent in a concise post from his self-titled blog explaining the value of ‘Keeping Perspective.’ He demonstrates that doctors offer meaning to our patients when we help them think through and make challenging medical choices. He gives several real world examples.

Jessie Gruman, founder of the Center for Advancing Health, sent in a poignant piece from the “Prepared Patient Forum” describing her frustration with how slowly the world of medicine makes progress. Using the metaphor of “It Takes Two to Tango,” she writes that a true patient-doctor relationship takes time and practice to establish. Forces outside of the relationship are often having a deleterious effect.

Medaholic, a medical student from Canada with an eponymous blog, posted about the time his grandfather was hospitalized and the formative emotional impact that it had on his medical education.

Elaine Schattner posted her reaction to Abraham Verghese’s novel Cutting for Stone on her blog “Medical Lessons.” The book raises the untold issue of doctors going into medicine to heal ourselves. Hmmm…..

Pranab Chatterjee, a fascinating medical blogger from India who writes at Scepticemia.com, sent in this post finding meaning in the “…madness of…[a medical school] examination.” I can’t believe the nutty things they ask on exams there. I’m glad the concept of ‘educational reform’ has taken hold here in the U.S.

Paul Auerbach, a professor at Stanford and the foremost authority on wilderness medicine, wrote in: “One of the ways that I find meaning in medicine is by educating people. There are many ways to feel good about being a doctor; one of them is having the opportunity to deliver information that might truly help someone prevent or treat a disease or injury.” He sent in a post clarifying breast cancer screening recommendations, particularly for patients that might be going into the wilderness for any length of time.

Finally, Dr. Grumpy, a prolific and funny medical blogger sent in this holiday-themed photo, positing for those that want to keep Christ in Christmas:

Happy Holidays!

Dr. G always reminds me that humor is the highest form of defense mechanism against medical, winter or holiday doldrums. And not taking ourselves too seriously has great meaning.

Grand Rounds will return to the blogosphere in 2012. I wish you a healthy and happy new year…and may the Force be with you!

Finding Empathy

empathy personified

Most people enter the healing arts with a genuine desire to serve others.

The long educational journey and the realities of both the workaday world and the various business models of health care often strain our abilities to act in an empathic manner.

We have to pay the bills, after all.

“No money, no mission,” is a refrain I’ve often heard in the non-profit corners of the health care world, justifying business decisions that on their face seem less than patient-centered.

I hear stories all the time from patients, families and friends about just how far we have to go to truly become patient-centered in our approach to providing the best in health care.

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