Why I don’t want to be “House” anymore

Once I’d decided to be a doctor, I turned into one of those people who watched every medical drama available (I was a TV restricted child/adolescent, so apart from “The X-files” medical dramas were pretty much all I watched from aged 10). I watched them all until I went to university and didn’t have a TV anymore. We’re a relatively healthy family, with relatively minimal contact with health services. So, my ideas of what made a “good” or a “bad” doctor, and what it meant to be a doctor were almost entirely based on TV series. (My father did buy me some literary medical classics, but only once it was fairly clear that this was what I was going to do with my life.)

I’m 32, so “my” doctors came from Casualty, Chicago Hope, ER and Cardiac Arrest. And House. I still don’t have a TV, so it’s been some years since I watched any of these, but as far as I remember the format was as follows:

Casualty: UK based, acute admissions. Usually had three storylines in each episode: one ended badly, one ended well (usually resolving some deep-seated family trauma). Unusually, the storylines started with the patients, in their own homes. The big trauma/accident/illness happened about a 1/3 of the way through each episode.

Chicago Hope: American, tertiary hospital. It had a paediatric surgeon in it (which was probably why I watched it). Very Dr based (I don’t remember any other health professionals). Lots of ethical dilemmas about which treatment was best

ER: George Clooney, and he was a paediatrician. And it was about “real” people in a public hospital. (And it was a good way of learning adult emergency medicine – the first x-ray I saw of a widened mediastinum was on ER)

Cardiac arrest: rumour has it that this UK based hospital drama was axed by the BBC for being too realistic about junior Dr working conditions at the time… but it’s the show that made me want to be a Dr

House had/has Hugh Laurie being an obnoxious, arrogant genius who actually has a heart of gold and fixes his patients (through a battery of investigations and some seriously clever thinking)

These shows all had a strong moral message: healthcare professionals who worked hard for the good of their patients.  When they put their own interests or needs first, the patients suffered, and there were consequences.  (Anyone else remember this scene from ER?)

What all these shows had in common was that doctors made decisions for their patients. And House epitomised this: he was so completely sure of himself and that he was doing the “right” thing for the patient. Even if it wasn’t what they wanted. At the time, and for a long time, I thought this was great. Look at him being the ideal Dr; doing the “right” thing for people even if they didn’t want him to. That was the skill I aspired to – to “know” what the right thing was.

I don’t think anything in my medical training thus far has given me any different role models.  Yes, I’ve sat through consultations and teaching sessions about “shared decision making”, but it’s always been on our terms; different variations of what we think are ways of getting a “good” outcome.  Balancing risks that we think are acceptable for outcomes that we think are good; usually ones that can be measured in easy to read numbers.  And if the people who are really involved start to question what we have decided is a good outcome; what this child’s journey through life should be, what then?

I used to work on a neonatal unit.  Staff were scrupulous about finding out what the families wishes were when it came to possible end of life decisions; what families wanted and where their limits were of what they wanted for their child.  I don’t think we do the same for children’s lives, everyday.

As doctors, we live in a medical world.  We have our social norms of what we think is acceptable; what we would want for our care; what we think we would do in certain situations.

Maybe we could just ask? Ask the people who matter, who live with the consequences of our decisions every day. Stop just deciding that our “right” decision as medical professionals is the right decision for that family. Stop thinking that our world is the “right” way, and that our “good outcomes” are good for everybody else.

Popping the delusion bubble

I’m really struggling with my PhD, and not for any of the reasons I was expecting. (I mean those are all there: time pressures’ recruitment; really, really just wanting to have a day off…).  I’m struggling because I suddenly get access to people’s lives when I’m not a doctor, and it is making me question everything about my doctoring.

I’ve always liked listening to people: it’s the best part of my day, and the part I miss most about no longer being a medical student.  I know that whatever I hear as a doctor is going to be restricted by so many things: time, fear, power.  Despite all this, families let you have access into their lives in a way that I don’t think you get outside of healthcare.  It’s what makes working in health such an enormous privilege; it’s why this is the most amazing job in the world; and I love it.

I’ve always *known* that all families are going to share is the tiny bit of their lives (and the why of that is complicated. and not what I wanted to talk about here).  But I was arrogant enough to think that we, as a group of healthcare professionals, were a group that families would share things with.

Oh, I was so wrong.  My PhD involves me listening to families real lives in a way that I can never do as a Dr; trying to understand how they work with the health services to live at home.  The way people talk to me in research mode is completely different to how they talk to me when I’m wearing a stethoscope, and we’re in hospital.  (Stating the blindingly obvious here…)  I *know* that people are real people, at home (not in clinic or hospital), living… And I *know* that healthcare professionals are notorious for not really understanding this.  I just wasn’t expecting the gulf to be so huge.

What’s really getting to me is that nobody expects the Dr side of me to “get it”.  Families expectations of their care is that we haven’t got a clue, and they don’t expect us to.

But why should I? Why on earth should I be able to get this insight into people’s lives just because they happen to be sick? Does it help? Is there anything I can do about it anyway?

This is not the medicine I thought I was practising.  This is not why I wanted to be a doctor.  I was quite happy in my little Dr bubble which said that as long as I “did” the communication skills, and practiced my active listening, then I could be the good Dr that understood just a little bit.  And one day, I thought, I could make a difference.  Maybe I could listen to how people were managing; maybe I could do something about it. And I can’t.

And a huge, huge part of me just wants to block it off. To say that “that’s just the way it is”; that I’ve over-analysing what I’m hearing… Because I don’t know why I’m a doctor if I can’t even listen to people