What’s Wrong With American Doctors?

By BRIANNA GRAFF

It is February of 2005, and my grandpa is lying in an Intensive Care Unit bed at Beth Israel Deaconess Medical Center in Boston, critically ill from a renal artery rupture that planted him face-first in his parlor. As a functioning alcoholic who has already been in the hospital for a day, he is beginning to shake periodically, a sign of his withdrawals.

Still, it will take another twelve hours and exasperations from both my mother and grandmother (both nurses themselves) before the physicians get him the Ativan he needs to combat this symptom, which is small potatoes compared to his emergent reason for admission.

While he would eventually make a full recovery, in those few hours my grandpa had tremors he was also the unintended victim of “tunnel vision” exhibited by many physicians: they see the most prominent problem and address it, often losing grasp of a holistic view of the patient and neglecting his humanity in their attempt to treat him. In short, they see the medical problem as opposed to the entire person.

Of course, this doesn’t mean that doctors are heartless: the number one reason doctors choose the profession is to help people, and the grueling work it takes to become an MD is clear evidence of their devotion to their career. So how did we end up here, with doctors overlooking the humanistic nature of their work?

The answer: their education. The one system we trust to build our caretakers is also giving them the short end of the stick in the social aspect of their work. Physicians take a slew of scientific courses to prepare them, but few get valuable social education. Clinical experience doesn’t begin until the third year, whipping through short rotations and involving a “hidden curriculum” in which students learn to communicate with patients by watching their superiors. What results is a breadth of experience, but no depth in bedside manner.

According to a study published in the Social Problems journal, doctors feel they can learn more from the medical chart than from the actual patient. What’s more, their main motivation for speaking to a patient is to gather information for said chart. To top it off, doctors spend hours making rounds, discussing the patient publicly among colleagues but rarely addressing the patient directly.

One junior resident in the study summed it up perfectly: “If you don’t sit and talk with a patient for a half hour, in terms of your job description no one is going to be mad at you. But if you don’t know what the hemoglobin is on the patient, the chief of medicine is going to be very upset with you.”

Clearly, doctors are more concerned with getting the job done than having a personal touch with patients. This might be beneficial—the more people they can cure, the better, right? Not true. A study conducted at Stony Brook University shows that compassionate, attentive care results in better therapeutic impact for patients and lowered depression rates with elevated career meaning for physicians.  It creates a better reputation for a healthcare facility at no greater use of economic resources, too.

Appropriately educating our physicians to be socially competent might seem difficult to add to their quest for an encyclopedic level of scientific knowledge. However, some schools are already doing it. Harvard and NYU give medical students practice with patients from day one. Schools increase their diversity to give their students a wider perspective and more capacity for empathy. It is proven that we can teach people how to express compassion in the clinical setting, which alone could dramatically improve the way we provide care.

We should be implementing these strategies across the board, as opposed to hoping doctors inadvertently learn communication through fleeting clinical experiences.

In a world where quantity supersedes quality, we need to take back the reigns and create renaissance men of medicine, where the demands of education don’t erode the ethics of students and destroy their idealism for their careers. The welfare of patients, doctors and the entire healthcare system depend on it.

Brianna Graff is a nursing assistant in the Medical ICU at Brigham and Women’s Hospital and a pre-med student at Boston University.

 

 

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