Ana Rajicic, Medical Student, 5th year
‘You have to read that book as a medical intern.’ The House of God by Samuel Shem is recommended by everybody. On my 23rd birthday it was gifted to me by two friends. After reading the first 40 pages I felt annoyed. Why is this author so condescending when it comes to elderly patients? ‘Gomers never die.’ what nonsense, I thought. The inevitable slap in the face from reality came the next week of my internship. The family of a 74 year old patient in coma was asking how much longer this was going to last. The patient was supposed to die within four hours according to the doctor. This was three days ago. Maybe Shem has a point.
Nonetheless the first pages of his book have repelled me so, that I have postponed reading the book for over a week now. The thing that revolts me the most, is the cold approach towards patients. Patients are now and then seen as projects instead of people in our profession. For interns patients are educational projects, opportunities to practice theoretical knowledge and improve clinical skills. There is a reason why we talk about ‘cases’. In this way we can distance ourselves from the individuals behind the disease. We only consider the consequences of a disease on the personal life, if this is relevant for our treatment policy. I don’t think this is either good, nor bad. Maybe this is unavoidable to be able to treat patients day in day out without getting too occupied by their life. However, in some cases I think a certain amount of chitchat is necessary to build a safe environment for the patient and set him/her at ease. I don’t know whether this is the empathy the psychologists meant in our classes on ‘conversational skills’…
"For interns patients are educational projects, opportunities to practice theoretical knowledge and improve clinical skills"
During our training we are bombarded with ways to react empathetically. The best way according to research appears to be explicit empathy: ‘I understand that you feel this and that, because of this and that.’ This has never worked for me. Every time I tried to utter a sentence like that in practice sessions with actors, it felt feigned. That’s exactly what it’s not supposed to be like. This is why I was told to work on my empathy during my bachelor’s degree. I was too concise. During the master internships I have rarely had this feedback. In practice I am much more involved with a patient and the empathetic reactions come naturally. Yet, I wonder whether this will stay the same in the future. How can you keep being empathetic, when you have seen the same case a hundred times? And on the contrary how do you prevent yourself from getting drowned in the patients’ troubles? Finding this balance is a challenge.
