I found this thought-provoking blog post from a 4th year North American medical student on the computerization of med school. As naturopathic medical students we like to think that we’re the only healthcare professionals that actually “care” about people. However, this is simply not true. I believe that most people get into medicine – any kind of medicine – for the right reasons, one of those reasons being a love for humanity. It’s only whether those reasons are still with us at the end of the 4 years that truly makes the difference.
I remember speaking to a 4th year intern in September, asking her how she thought the first months of her internship were going. “Great!” she replied enthusiastically. This isn’t surprising, as preparing for the internship year is really what the first three years of intensive study are all about. I asked her if she had felt prepared entering the clinic. She thought about it and responded, “Yeah, I felt prepared… but I just wish we had more practice in something. I can’t put my finger on it…” She thought about it for a second and then said, “yes, I know what it is: the doctor-patient interview.” Otherwise known as the ability to communicate with and develop a healing relationship with patients.
In the previously-mentioned medical student blog, the author reflects on the fact that, in studying for the numerous pathologies and treatments and sifting through the millions of factoids that we must juggle and then recite, in order to impress our residents and TAs, the actual people who these diseases represent get lost in the acronyms. He writes, “sometimes we forget that the textbooks are about the people around us.” As an example, he mentions his failure to be there for a friend who had hyperthyroidism, a common medical school pathology that most of us have studied inside and out.
Rather than jumping at the chance to interject with statements about how naturopathic medicine is about people and that we don’t let people get lost in all the paperwork, I have to take a moment to silently grieve the (hopefully temporary) loss of humanity that we experience in medical school. We may know the textbooks inside and out, but what do we know about the people who the textbook blurbs are based on? We say that patients are people, not diseases, so why do I constantly hear patients being referred to – sometimes even by myself – as “the fibromyalgia case”? As our focus turns to completing assignments, most of the time we can’t even remember the names of the people were are supposed to be treating.
When we meet with a specialized patient (SP) in our Primary Care practicals, are we concerned with the actual person who sits in front of us? The answer is simple: there simply isn’t time to care. Our neurons are firing together in one anxiety-driven purpose, which is to find the disease that our fake patient is presenting with. The fact that the patient is fake, and acting, makes it even easier to bypass the human in the seat across from us. Their bodies simply serve as a vessel to provide us with information.
This seems ironic to me, because one of the things we naturopathic doctors like to brag about is our unique ability to relate to patients, our skill at interviewing them and creating a safe and open space in our clinic rooms. After three years of naturopathic medical education, I’m wondering where this value has been tucked away. In all fairness, there’s not much that’s humane about being held captive in a lecture theatre for 40 hours a week.
This week I’ve noticed a few instructors reassuring us that the most important thing we can do as practitioners is listen to our patients and form a doctor-patient relationship; the rest is just tinsel on the tree and can easily be looked up (so, why all the memorization, if this is the case?). While it is important to learn the facts, I find that our education does not reflect the emphasis on relationships that our profession as a whole seems to deem so essential to our practice.
And so, if doctors are simply hard-drives used to store textbook information, then it follows that, like factory workers, farmers and even cashiers, we can eventually be replaced by computers one day. Like in the (very underrated, in my opinion) movie “Idiocracy” I envision a future in which a patient sticks their hand into a machine, which automatically takes a blood sample and then brightly declares, “you have hepatitis!” as the now dejected-looking patient sidles out of the office. That is, unless we somehow recover our long-misplaced humanity. Maybe we should check to see if it fell behind the couch cushions…
Perhaps when we enter clinic and meet our “real” patients things will be different but, for now, I think it’s appropriate to grieve the stripping of our humane selves, including the people we were in 2010: young, eager to help others and enthusiastic about making the world a healthier and happier place. Hopefully we’ll meet up again in 2014.