Sometimes we forget that the textbooks are about the people all around us…

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.

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12 thoughts on “Sometimes we forget that the textbooks are about the people all around us…

  1. Perhaps it is the fact I’ve been skipping a lot of class and not being held captive in that god forsaken lecture hall quite so much, but I’m actually feeling way better about CCNM and becoming a doc in general. This whole post completely echoes how I felt last year, drowning in clinical medicine and the like, and of course got stupid comments on any post I wrote about how I should pursue something that made me happy and that I was giving CCNM a bad reputation by saying all this. Newsflash… as you’ve pointed out, Talia; all med schools face the same problem, naturopathic or western. We came into this for a reason, to follow our passion, and our passion was helping people, yet in order to help the people, we are forced to rum the gambit of facts for three years and pray there are people at the end of it. And so essentially we get steered away from our very passion for three years and asked to have faith. I’m finally seeing the light at the end of the tunnel, and no thanks to the knobs that commented stupidly on my blog (I’m over it, for serious). I’m glad there are people shedding light on this problem with school in general, I’m glad there are med students from various schools shedding light on this problem. It doesn’t give CCNM a bad rep it gives the entire North American school model a bad rep because it IS bad. It IS bad. It’s that simple. We’ve traded people for textbooks. Thanks for being another voice in the fight and as DeMartini says – no pleasure nor pain shall stop you in pursuit of your higher value. This pain too shall subside. We’ll see our old selves on the other side. Until then I guess we gotta hang up some tinsel.

    I f**king hate tinsel.

      1. hahaha tinsel is dumb, it’s like the STD of Christmas decorations… didn’t a friend of yours say that? I realize with my post I’m not being entirely fair, I mean we DO, compared to probably many med schools get back in touch with a more patient-centered way of dealing with disease. But, while listening the the lecture on disordered eating I (to my horror) found myself wondering “where are the studies that confirm what she’s saying? How would I chart that? What treatment would you give them? Would you treat them for their ED without telling them you’re doing so?” And then I realized that the lecture wasn’t about “treating” eating disorders, it was about treating PEOPLE who just happen to have eating disorders – completely different way of looking at problem that I used to have no trouble doing and now find I’m being conditioned to the other extreme: a world of clinical guidelines, likelihood ratios, a swimming pool of Pubmed papers… I KNOW that these things are necessary for the practice of good medicine, but I know we all came here for something more. However, I should add, that, unlike the blog the med student wrote, we do have an opportunity to redeem ourselves when we leave school because we have as long as we want to spend with out patients, while the medical system doesn’t alott their doctors that time. I just wish this very important principle were ingrained in our education. I think it would really help unify our profession.

  2. Well written Talia! As an outsider to your profession my commentary will only be accurate as an outsider. The socio-political climate in which your school exists REQUIRES your education to be centered on memorizing facts and passing tests. Being under the RHPA means that ND students/candidates must prove they are capable of passing standardized tests…for the protection of the public. The governmental validation of any health care profession means that it must pass the litmus test of the standard MD model or be classified as “less than”. The good thing is that once you are in practice you will not be part of the socially funded medical system, you will be a conscious choice in health care. You will not be an alternative – you will be a health care provider that is deemed important and effective to the degree that your patients will forgo the social system and see you for your services. You will be your own boss. You will choose how you practice. You will choose your modalities. You will choose how to commune with your patients. You will essentially be writing a “choose your own adventure” novel. Your constraints will be minimal compared to an MD – you do still have to abide by the RHPA or else your college will have no choice but to protect the public from you 😉
    Most education has nothing to do with teaching students how to perform the chosen profession, it has to do with hitting the benchmarks of those that control the profession (not the public – the regulatory bodies). There is a lot of money involved to maintain the status quo (it has been maintained for over a century – look up the Flexner Report and consider that it was funded by the Carnegie and Rockefeller FOUNDATIONS with the recommendation that all medical education in Canada and America should look like Johns Hopkins). You pay a lot of money to get through that system. Once you are through you will have some breathing room.
    It is all on you and your colleagues when you get out of school and in to practice. There is a lot of responsibility for your own success and you will all get to choose how much of it you take on. In the process of taking back your own direction through conscious choices you will have the opportunity to regain that human connection, to treat the person that CHOSE to see you, and that is a beautiful thing.

    1. Thanks for the comment, Sam! You’re right, I don’t think our school is consciously leaving out the human aspect of our education, and I think they’re actually trying to fit it in. You’re right in saying it’s a diverse profession, that patients should do their homework and pick a practitioner that is right for them. And, of course, you’re right in saying that the requirements we face in terms of education have more to do with passing licencing exams than much else. I’m simply writing to express frustrations with being institutionalized, and the failure to treat compassion and humanity with the same importance that we treat knowledge of the Kreb’s Cycle. Being well-versed in both, in my opinion, is the cornerstone of our profession. But, in hindsight it might very well be up to the students ourselves to create these opportunities through volunteer programs, botanical medicine- appreciation clubs, philosophy groups, meditation circles, etc. I appreciate all the feedback.

      1. There seems to be quite a bit of energy from CCNM’s student body to provide themselves with the opportunities that may not be provided by the institution. Those that want the opportunities will create them. I would assume that there are many people in the institution that are doing everything in their power to make the educational process more “naturopathic” within the confines of the regulations they face. Keep venting – I have been told that if complaining (in this case venting) helps you get the job done, do it (catharsis can be a wonderful thing)

  3. I saw this because Katie Smith said it was a good read, and she is right 🙂
    In my global health head, there’s a graph of time vs. volume. So many need help, and finding your own intersection between depth and time balance is key to your happiness as a practitioner. Some docs like a fast-paced practice, quality human contact or not (fewer happy this way). Some like to do 3-hour homeopathic intakes with everyone (fewer seeing enough patients to make a significant impact on the health of their communities). I hope you find that balance for yourself, as I struggle with this constantly working in such widely-disparate venues with different needs. From a practical perspective, I find myself doing my best work when I’m seeking the WHY in my patients while being their cheerleader.
    Thanks for shedding more light on this issue which IS still relevant to ND school (maybe increasingly so)!

    1. Thanks for the visiting this site and thanks for the comment! I agree with what you’re saying, just as in trying to balance the scales of health in our own lives, so must we balance our own practicing styles. It will take a journey to get it right, for sure. But it’s nice, as students, to contemplate these issues now and create some meaningful dialogue on what’s important and, perhaps universal, when it comes to creating a fair representation of the principles of our profession. And, you’re right, taking time to ask and listen for the “why’s” (and also the “who’s”) are what I’ve been hearing a lot of lately. I think it’s what sets us apart from the “what” and, sometimes “how’s” (rarely)that are the main focus of the other medical professions.

  4. It’s interesting how as a teacher I can completely relate to your post. I taught at an inner city school for two years where the teachers don’t receive any support and are blamed by higher ups and the general public for low achieving scores. I can honestly say that every person I met working there really cared for the children. I think most people go into these professions with a true desire to help others but many times can’t do what they think is right because of protocol.

    1. It’s a struggle between doing what you believe is right and following that with confidence and adhering to what your institution requires of you. Oh, the perils of being “institutionalized!” But I think it’s healthy to sit back and reflect on whether this is what you want and then recognize or work to change that which you can. It’s tough and I’m still working on it and, as I’ve done for most of my adult life, used what I don’t like to help steer me back onto the right path. Thanks for commenting!

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