Saturday, September 17, 2005

Surgeons vs. Humans

Today I was reminded of the strange disconnect that happens to us in medicine, the wall that we erect between ourselves and the patients we treat. This is something that happens in all sorts of little ways at first, and progresses.

When you're in medical school, every patient is an individual. You have plenty of time to get to know them, and you any they share about the same level of medical knowledge, really, so at least at first you feel more like them than the medical team you're a marginal part of. (For an interesting discussion of the state of medical education today, by the way, see this recent article from the NYT, which captures the picture very clearly and quotes some people I know very well.)

It doesn't take long in residency to start objectifying. First, I found myself doing something that I abhor in others, which is talking about patients and people "that" do things, rather than "who." It's the first step of objectification. Then, the other day, I was looking at the board in the ER for a patient that -- there I go again -- was coming to the service, and I actually referred to the patient as "it." And I knew then that I had truly crossed over.

Today, instead of clinical service, all the residents were due at the local surgical society's annual conference. One part of that was a discussion of medical ethics and disclosure of medical errors, which I've had an interest in since a failed attempt to make a film about that topic in medical school. And what was amazing was the way that the two hundred people in the room seemed utterly baffled by the human condition, trying to devine the simplest, most common sense facts of human nature and common sense from a series of presentations of convoluted data. How is it that they - we - cannot reflect deeply enough on our own humanity to be able to answer the question of how to deal with patients with our own projection of how we would like to be treated. How is it that we can come to view patients as being something totally different from ourselves, mysterious and unknowable?

Sometimes I feel that this program is changing me on some fundamental level. Sometimes I think that's a good thing, a breaking-me-down-to-build-me-up, military model that will allow me to find new depths of strength and ability in myself. But I do want to come out remembering that only time separates me from being the doctor and being the patient in the bed.

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