I Could Have Been a Doctor. I Should Have Been a Doctor?
I could have been a doctor. I should have been a doctor?
“I want to be a doctor,” I told my mom once when I was nine. We stood on the cement “porch” in the front of my mother’s mother’s house in Plantation, Florida.
“Don’t tell your grandmother,” she had warned.
I sat on the couch this week watching the Crystal Apple awards sponsored by the local news station. I had considered submitting my gym trainer at one point, but figured she wouldn’t come close since “teacher” almost always defaulted to its definition by place. Teacher meant classroom only. Also from the clips and descriptions of the winners and runners up, teacher also continued to mean mother.
“She always makes sure her students have warm clothes.”
“She selects the most effective techniques based upon her student’s needs and goals.” I crossed my fingers to hear that characteristic next.
Instead the announcer read, “She takes the time to help form the children’s character.”
Maybe if I waited, I would hear how the winner takes the time to read the most current articles about instructional practice or discusses professional learning with her peers during lunch.
The announcer finishes with, “Overall these great teachers always have the time to listen.” Listen. That was interesting. If "teacher" was still what I was sure I wasn't. What else could I be?
I recently read What Patients Say, What Doctors Hear by Danielle Ofri, MD published in 2017 by Beacon Press. She described her book this way. “In this book I trace the paths of several patients and doctors, examining how a story travels from one human being to another. By exploring the challenges and pitfalls, as well as the collaborations and the successes, I hope to illuminate the role of this most potent diagnostic—and therapeutic—tool in medicine. The more technologically advanced medicine becomes, the more we are reminded of the crucial role of the story.” (6-7)
Of course listening is important, but what are we listening for? Does profession matter when it comes to how those skills are valued and judged? And, more importantly, who are we while we are listening? I will leave it to you, the reader, to judge. Listed below are a few of my favorites, and maybe some professions I should, or should have, considered.
“When I’ve thought about why my hackles get automatically raised, I’ve usually chalked it up to the volume of requests. . .But Debra’s study made me wonder if I’m perhaps reacting unconsciously to the ceding of control. In more-typical visits, the patient brings up a few things and then—if I look honestly at myself—I take over the conversation. I rapidly prioritize the issues and then start asking the questions that eventually dictate our course of action.” (45)
The relationship is the most powerful and influential part of a medical treatment. (53)
The pitfalls are: standard recitation of facts with or without emotion to persuade, nagging, threatening to withdraw as the doctor.
“. . .the strategy of repetitively hammering in the facts rarely achieves the desired outcome. . .(59)
“Herein lies the rub: something that simple and intuitive, something that doesn’t require specialized knowledge, can feel threatening to a physician who has spent a decade training to acquire unique medical knowledge (and $100,000 of student loan debt). I mean, it’s not a lot of sweat off anyone’s back to be a more engaged communicator, and if it doubles your patient’s pain relief—why not? It’s the very simplicity, I think, the lack of sweat off one’s back, that makes it seem so squishy and simplistic to we doctors who frame ourselves in the scientific mold. There’s something vaguely discomfiting to realize that the techniques shamans used centuries ago can sometimes be as effective as our pharmaceuticals backed by million dollar mega-trials.” (89)
“I loved the idea that a doctor and patient could be co-narrators in the story.” (116)
“I also remind myself about the limited utility of constant repetition. . .Simply repeating, ‘cut out the white rice, eat more vegetables’ doesn’t get anyone anywhere. When I find myself on the verge of trotting that phrase out again, I try to stop myself and instead ask, ‘What are the hardest challenges in dealing with diabetes?’” (125)
“No two people speak the same language,” Ogden told me in an interview. “They have different childhoods, different cultures, different family backgrounds, different contexts.” With doctors and patients there are additional realms of difference: Doctors have a specialized knowledge and vocabulary that may be entirely foreign to the patient. Patients are experiencing symptoms that the doctors are not, and each patient has an individualized and complex response to being ill. (168-169)
“. . .there is an increasing tendency in medicine to try to make patients happy. This is partly due to the salutary attention being paid to the humanness of the doctor-patient connection, but also due to the ever-burgeoning business side of medicine.” (169)
“Listening to a patient might seem like the easiest of the many medical skills that a doctor needs to master, but in fact it is one of the hardest, especially if you want to do it well.” (196)
“My ingrained habits didn’t rectify overnight but I did start noticing some of them. Usually it was only in retrospect, after the visit was over, that I recognized my blunders. But occasionally I could catch myself in the act.” (224)
However, these quotations are excellent reminders of the fact that when we work hard and pick our own skills to improve, we should take the time to balance our choices between hard and soft skills and manage our expectations no matter who we decide we are going to be when we grow up.
The author finishes with “The hardest thing by far is trying to rout out my biases. No doubt they are so ingrained culturally and personally that I’m not even aware of most of them. But I’m making an effort to notice them, and to confront them when I find them.” (225)