Wednesday, February 15, 2006

Lost Souls

This is one of the reasons I started this blog. I've had several ideas for things I need to write about related to... medical training. Some of them are related to patient care, but some, like this one, is about the training system itself. I think the system is very good at what it does - it takes an average college graduate, crams a bunch of medical information into their head, and at the end of the road, you have a doctor who can take a cookie cutter history and physical, can formulate differentials as the patient speaks, and can describe a patient in two sentences that's filled with more medical acronyms than words.

Where it fails is best put by Rufsvold and Remen:"Year after year, students enter medical schools across the country inspired to become doctors... Numerous studies reveal that four years later, this excitement has given way to numbness, cynicism, and depression..."

Why does this happen? I think the simple answer is that training isolates us. Medscape recently had an article on whether medical training "strips our souls" - and I think to some extent we are dramatically changed. I am a very happy physician and love what I do, but I was also fortunate to be able to make the choice to train in a more benign specialty. As I watch my surgical* friends and even some internal medicine* classmates, it's frightening how quickly and easily one loses the perspective of life beyond medicine. It's easy to lose perspective, seeing as how, on a q3 rotation all you can do is show up at work, work like a dog, miss meals because the day got too crazy, go home and have to choose between eating or sleeping, and schlepp to bed knowing that you'll just have to do the same in a few hours. The transformation begins in the third year of medical school and slowly worsens so that a surgical resident wakes up and doesn't bat an eye about doing 100 hours (oh, I mean "80") a week in the hospital. Imagine if you took the average college pre-med and showed them a 30 hour call with no chance of sleep. And then showed them that that would be their lives for 3 years. Or 7. Would they still be pre-med? Maybe not. But it's often too late when you realize what kind of path you're on, and you've come too far to look back and change your mind. You've already given up a lot and you go on thinking, "it'll get better someday." Someday never comes until one day you're a tired mid-thirties man who has finally finished a fellowship, has a saddle full of debt, have to look for your first "real" job, and you go home to the empty apartment that you still rent. Your college friends are married, some have children, most own homes, and many have already been promoted several times in their careers. If you took that pre-med and showed them that moment, would they still be pre-med? Maybe not. Training has the potential to become a slow, progressive isolation from the rest of the world. The people and things that keep most people grounded are no longer there. You become who you are at work, a surgeon who saves lives on the operating table, an internist who uses pills to chase after lab values and spends way too much time with paperwork and dealing with insurance companies, because what else do you have? What else are you? That well-rounded profile that helped you get into medical school has long fallen by the wayside, just another victim of the brutality of medical training. How else do you think that the monsters that throw scalpels in the OR come into being?

* Note: Surgery and internal medicine are used here purely as illustrative examples. They are wonderful fields that are extremely rewarding and we all need good people going into these fields. They are mentioned here because of their large size and because they are the first big branching point in a medical student's career. This "isolation" has the potential to occur in any medical field, and as with anything, there is a combination of environment and genetics - each person's likelihood of this happening to them is different. Also the likelihood of this happening depends very much on the type of training program (community versus academic) one chooses. Some are more benign than others.


Anonymous Anonymous said...

It would be a much more pleasant & soulful experience for the patient if somehow med-school didn't suck the life out of it's doctors. I avoid Dr.s in general.

8:32 AM  

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