Tuesday, January 27, 2015

Be Kind To Doctors

Actually... be kind to all those we meet... the ripples of kindness should not be underestimated...

Contrary to popular media, doctors are human too. Doctors are born, live, and die just like everyone else. There is nothing inherently magical in the preparation of physicians that mould them from soft and fleshy homo sapiens with tender souls into hardened robots with scientific logic. In fact, doctors may be more fragile than the average population if one were to consider the statistics. Increased burnout. More depression. Higher rates of suicide.

And yet, the fa├žade persists.

On the outside, you probably won’t see a difference. I doubt it’s possible to observe the slight tremor of my hand as I log onto the computer or the subconscious tremble as I ask what I can do for you as your primary care doctor these days. I hope you won’t notice actually. You can’t see the emotional scars that I carry from working in the field of medicine and occasionally getting caught in the crossfire of a frustrated injured patient hurtling arrows of hurtful accusations at the profession, or having a previously healthy man die underneath my hands doing CPR, or failing to resuscitate a tiny stillborn baby. Some arrows hit harder than others. More recently you might have heard the pieces come cascading down in a tumbling avalanche of shattered glass in fact. Those were the broken bits of my self-confidence and belief in the goodness of humanity slipping into a million tinkling shards that were washed down the drain by a flood of invisible heart tears.

Yes, doctors are humans too.

In spite of our outward professional personas of academic intelligence and logical reasoning fraying at the edges by a frenetic schedule of sick patient-visits and overwhelming written documentation, physicians are every bit as human as the breastfeeding mother in the nursery or the elderly man who sheds tears over his wife in the ICU. Doctors find themselves in those situations too – perhaps  they’re at a disadvantage because some have sat on both sides of the fence where a certain amount of “ignorance is bliss” might have helped.  

White coats and name titles like M.D. and D.O. do nothing to protect us against the stinging angry words of unhappy patients. 

“I find your attitude rude and arrogant!” the patient stormed out of the examination room.

“I’m so sorry. I truly didn’t mean it that way. I was just trying to provide the best health care for you…” my apology backpedalled aimlessly into the dust as the door shut against the agitated figure of the elderly patient. Her abrupt departure was unexpected to say the least.

My initial reaction was shock. What?! Did she really just leave?

Within seconds this morphed into a more enduring crush of nascent confidence. My stomach plunged to dark rocky depths in the split second it took to log off the computer and realise there was nothing I could do to placate the agitated patient-client. She was gone. Redemption disappeared at the slam of the door.

“Um,” I turned to the nurse helping me that day, embarrassment and shame slowly dawning upon me. “What should I do?” I asked her. “My patient just walked out on me. She said I was rude.” It hurt to admit anyone would ever say such a thing about me.  I like to believe that I am generally professional and able to communicate at least on a doctor-patient level with almost anyone. Clearly I’d struck a sore nerve. I had offended the patient. It was a miscommunication yet still it hurt.

It was an error in communication that ruined my day. As much as my intelligence assured me that I was still a competent doctor, I couldn’t shake that small nagging aura of foreboding. Someone out there hates me. Cognitively I know I will never please everyone but my heart still wishes such wasn’t the case.  In spite of my best efforts, I wish I could please everyone. My logical brain can accept that not everyone will be happy with my care. Statistically, I realise there will be a percentage of patients that are unhappy with my professional services for one reason or another, likely having nothing to do with my competence. Still… and yet… I felt horrible.

Yesterday a patient came to see me. “You’ve restored my faith in this organisation” she’d informed me. Her genuine gratitude brightened my day.

Others this week have smiled and thanked me for taking the time to listen to their concerns and answer their questions. “Is there anything else I can do for you?”

“No, doctor, you’ve taken care of me,” they’ve answered with smiles of relief that someone had taken the time to address their concerns. Now the multitude of their accolades was drowned out by the stormy waves of self-doubt. Why did one dissatisfied client erase so many positives? One angry customer nearly destroyed me. The peace of inner assurance in my abilities as a physician slipped away, overshadowed by the heated accusations of one unhappy customer.

Professional decorum dictates that I maintain a semblance of composure and immunity in such situations though. Tears were not appropriate. Other sick patients waited to be seen. There were many more hours to go until I could stop work. Life continued in spite of any personal feelings. “I feel terrible about this,” I lamented to my supervisor and again to my colleague.

“It’ll be ok. It’s happened to all of us,” my colleague gave me a sympathetic shrug. “Don’t worry about.”

“I know,” I gave a wan smile. “I still feel bad. It’s hard to hear how people misinterpret one’s good intentions …” my explanation trailed off. My colleague nodded. He understood. Neither of us needed to elaborate. I don’t know any physician who finds it easy to brush off the false accusations or dissatisfied frowns of short-tempered, angry sick patients.

Working with a population that is sick and frustrated with a complex healthcare system that treats them as a number and not a person, is inherently fraught with misunderstandings on all sides. Communication is never perfect and when physical illness is involved even less room for forgiveness is present. So why, in possession of this knowledge, do I feel so awful when someone is dissatisfied with my service or misinterprets my good intentions?

“I feel terrible.”

“I understand. I hate confrontation too. Even though I might not appear to mind, I still find such encounters difficult,” a more seasoned colleague tried to comfort me later.

“We’ve all had such patients,” another friend commiserated with me when I related my discouraging encounter. “It won’t be the first; it won’t be your last.”

I nod. What she says is correct. Still, it’s not terribly encouraging. Some days I think I must have chosen the wrong career. Perhaps I’m too sensitive. I wonder if I should gone into the food service business and found a job at Baskin Robbins scooping out ice cream to gleeful ice-cream fans or tossing pizzas for cheese and mushroom enthusiasts.

“I still get sweaty palms and palpitations when I have to confront certain patients. I know I’m doing the right thing by not prescribing their opioid pain medication but I still find such encounters very stressful.” It’s a common lament from many of my colleagues. On the outside, such doctors might appear strict and unyielding but inside most hate having to say no.

I don’t know any physician who finds it easy to disclose a terminal diagnosis to a patient and their family. It’s one of those inevitable responsibilities that fall upon a doctor; one that we shoulder as bravely as possible, but, like any human, not one we ever feel happy about. It’s not easy dealing with disappointed, suffering, disillusioned populations. And yet, physicians are asked to do such all the time. Mostly we manage. We muddle through as best we can – reassuring each other we’re doing the best we can while we reaffix our masks of professionalism at the beginning of our shifts. Underneath we are human though.

Yes, I realise people will get upset at just about anyone and misunderstandings happen under the best of circumstances. Still, I just want to say, please be kind to doctors. Physicians are humans too. We have feelings. Underneath our comforting smiles, cold hands (warm hearts), and white coats, we bleed blood crimson red just like everyone else. The tears that stain our hearts are not always visible to the public but that doesn’t make them any less real.

As I type these last lines I realise that the call to kindness is universal. It’s not just physicians who are fragile human beings that, in spite of their imperfections, still need that genuine kind attitude and loving concern. Each one of us carries those wounds in our hearts, invisible to the superficial gaze, yet very much real and so easily raked raw afresh. The Golden Rule comes to mind again.
“Treat others as you wants others to treat you.”

Kindness flows outward in a ripple of influences that shimmers beyond our imagination.

Be kind to doctors. Be kind to everyone. Be kind to yourself.

“Be kind to one another, tender-hearted, forgiving one another, as God in Christ forgave you.”

Ephesians 4:32