The conference speaker has just finished her presentation. There’s silence in the room. Then, a hand goes up and the inevitable question is asked:
“Do you think it’s possible to train doctors to care about their patients? If you showed them case studies like this?”
In the audience, I’m so stunned, I can’t think of a sensible comment to make. I don’t know what I’m more astounded by: the assumption that doctors don’t “care” as a default position; or the belief that listening to a 10-minute case study can give you any idea of what it’s like to be a person who’s a patient.
It’s not an unusual belief though. A quick look at the headlines tells you that doctors don’t care. We perpetuate this myth in research too: projects that look at studies of care in hospitals only look at non-medical staff; studies of interaction between nurses & patients are focused on care, those about doctors are sparse to say the least. Especially in my field of paediatrics, the idea of a doctor as someone who develops a relationship with a child is hardly acknowledged. Studies talk about the importance of including everyone who cares for a child in planning services, and then leave out medics (they often leave out the child too, but that’s a whole other issue. I will talk for ever about that if I get started). I was so shocked to read this about debrief, because it actually included doctors as people who cared.
But how much do you really want me to care? When I started in paediatrics, I found taking blood from children really difficult. Even with the best preparation & support, sometimes it’s just a horrible experience for the family & child. I found myself getting upset; angry with myself that I was putting people through all this. It’s not a helpful emotion. If anything, it feels self-indulgent.
I felt terrible about telling parents that their new baby might have sepsis; that they needed a lumbar puncture; that I had made them cry.
Here’s the reality:
My job is to be able to suspend emotion because otherwise I can’t function. Part of the skill set I have to develop is to separate my emotions from the patient in front of me. How can I possibly justify getting emotional about something that doesn’t really affect me? How can I allow myself to feel something that potentially impacts on how I do my job? I step away from one patient, and on to another, and another, and another. It’s not fair to one child if I’m still upset about something that happened 5 minutes ago; I go from sharing bad news to telling someone else they can go home to being shouted at for not having results back to apologising for keeping you waiting. I smile and play and laugh.
I hide in the treatment room for 2 minutes to let myself breathe; I go out and smile & talk & apologise & take histories & examine & play. I can’t care. Not then, not there. How do I give everybody else my full attention if I’m so engrossed in one terrible situation?
This is the other reality:
It’s the part of your brain that won’t let you go home until the test results are back. It’s the calling up a ward in the middle of the night to see how things are, or just wandering past on your day off to see what the scan showed. It’s remembering the look in their eyes when you tell them, and knowing that you can’t go back and intrude, that they probably never want to see you again.
It’s hoping that if I’ve done my job properly, they won’t remember me because I should just be part of the service that smooths them through the worst parts of their lives.
It’s lying in bed telling yourself to stop thinking about it; to not go back in just to make sure they’re OK: because tomorrow morning, you have to go back and do it all over again with somebody else.
But what would I know? I’m a doctor: I don’t care