18 July 2011

The God Complex

Tony Youn, plastic surgeon and author of In Stitches - a memoir about his experiences with the good, the bad, and the ugly - was recently asked to write an article for CNN.com about being a new doctor in July. He did. And in recalling the distant details of his harrowing initiation into the field of medicine, he was honest enough to choose a story in which he is not a hero. On the contrary, he described being placed in a situation he is unprepared for, one in which the patient survives his attempts to do the right thing primarily because the nursing staff is there to literally guide his hands.

As with all things medical, the responses to the amusing and self effacing tale are at times harsh. What interviewers and editors want is for doctors to open up about the uncertainty that exists in the practice of medicine, the nuances of which are unfortunately difficult to capture in 750 words or less. What readers (and consumers of medicine, for lack of a better term) seem to want, on the other hand, are doctors who are well trained, yet humble. To deny the possibility of fault is to develop a God Complex, yet to admit fault - to admit that the practice of medicine is messy and fraught with potential missteps and that the only thing that keeps the system running successfully is the teamwork between all of the different people who work in a hospital - is somehow to inspire condescension.

So let’s just be clear about a few points.

Not all new doctors are scared, but they should be. The ones who are scared, who can recognize when they need help and ask for it, those are the doctors you want working in your hospital when you get sick.

No doctor knows everything. Yes, there was a time when physicians used blood letting and leaches to treat fevers, when the sum total of medical knowledge was finite and flawed and, yes, maybe then it was possible for doctors to know as much about medicine as existed in books. Today it is simply not so. I would, however (and this is a radical statement), venture to say that the general increase in medical knowledge beyond what can be stored in a single brain is by and large a very good thing for patients. Embrace it. The doctor who looks things up is the one that you want.

New doctors, as riddled as they are with faults, are like puppies. They are highly trainable and they respond well to treats. If you find yourself in the hospital in July (heaven forbid) take comfort in the fact that the new intern who treats you will remember you forever. If your intern takes the time to explain something to you, or admits they have to ask their supervisor the answer to one of your questions, or even just asks you if you have any questions and stays in the room long enough to find out your response, reward them. Tell them you appreciate it and you will be training a doctor to be not only a better physician but a better human being for a long career to come. And if they don’t do these things? Don’t be shy. Tell him or her what sort of care you expect. The comment will fester and hopefully make a difference down the line.

Do I have a story, like Dr. Youn’s, of bursting into a room as a terrified intern and running a code? I do not. I’m a pediatrician. I had to ask approval of Julie, my first patient’s nurse, for permission to touch him for my entire first month. Every code I attended was standing room only, with ICU fellows and critical care attendings running the show. Children are precious. No hospital is about to let an intern slap paddles onto a coding infant’s chest. Nor should they. But the flip side of this coin is that it takes far longer in pediatrics than in other branches of medicine to gain the confidence that I’m sure Dr. Youn had attained only a few months into his training. Doing is learning. It takes patience and humility and there is nothing particularly God-like about that.

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