The dreams of the novice are pure. He sees a world of possibilities lying bare at his fingertips. Unencumbered by skills and knowledge, he practices the art of healing in it's most elemental form. Caring for humanity entails a kind heart, an available ear, and a pat on the shoulder. It is in these times, the seed is sown for an unswerving path. An ending that far too often has no recognizable remnants of such a noble beginning.
The mind of the medical student is already entrenched in chains. The subject is no longer humanity but a textbook of pathology. Facts, diagnoses, and algorithms lead the wanderer to stray from his path. To do no harm becomes the lifelong mantra that distracts the addled brain from the primary dictum. What once was the domain of the soul becomes fodder for the intellectual capacities. We learn the art of caring through a skill set, we subtract it from the core of our being.
The resident believes himself to be inching closer, not farther from the secret. Competence is the line between survival and failure. The punt, the turf, and the buff are perfected as if they were indeed the practice of medicine unto themselves. Fear and the struggle for survival detract from the ultimate goal. The distortion of the carnival fun house is almost complete.
The practicing physician wears a lab coat of many colors. One part businessman, one part computer technician, his role changes based on the needs of a complex and rigid system. He is both the keeper of facts as well as the follower of guidelines. He is the supervisor and the grunt at the end of the line. His loyalties are so divided between society and patient, that he has become utterly ineffective.
The secret is shockingly simple.
The novice was more adept in the art of healing than the byproduct of this dehumanizing process.
We must start again.
We must return to the beginning.
"We learn the art of caring through a skill set." Exactly. Some clinicians (and I can tell you are one of them) seem innately able to express caring as part of who they are, not just something they've learned or a cool skill they've acquired. There's a lot of debate among medical school faculty about whether you can teach empathy. I don't know the answer.
ReplyDeleteI do believe caring lies at the core of medicine. You cannot choose medicine as your life's calling without, on some level, caring about other human beings. Medical school and then the real world have a way of stomping out this fire (although some of this may simply be part of the life process; we all tend to lose some of our idealism as we acquire experience).
Maybe what's needed isn't to go back to the beginning per se, which implies shedding everything you've learned along the way. Maybe the real challenge is figuring out how to relight the spark, to reclaim the core that brings doctors to their profession in the beginning.