March 23rd, 2017

When Medicine Is Hard

Megan Tetlow, PA-C

Megan Tetlow, PA-C, is from Fort Myers, Florida, now working in Sheffield, England, as part of the National Physician Associate Expansion Program. She practices in gynecologic oncology and is a guest blogger for In Practice.

My posts are usually lighthearted and (hopefully) informative observations on the differences between my experiences in medicine here in the U.K. versus the U.S. But today I am writing about something that’s both personal and cross-cultural —  something that has at times been a struggle for me and likely has been a struggle for health care providers in every corner of medicine, whether we talk about it or not. I’d like to write about when medicine is hard.

By hard, I don’t mean the administrative hurdles and organizational dictums that occasionally make medicine a bit annoying. Nor do I mean the diagnostic puzzles that make health care interesting and challenging. I mean when medicine is emotionally noxious. For me, in my work in oncology, a hard moment is when my clinical skills have led to a definitive diagnosis but that academic success is eclipsed by what the diagnosis means for the patient. I know that tomorrow in clinic I will sit face to face with a person, not a histology report, and use the words “cancer” and “staging” and “aggressive.” That I’ll deliver news that, no matter how kindly spoken, will be a destructive, emotional wrecking ball.

Then, because I’m a professional, I’ll walk out of that room and go about the rest of my day. I will still have a full clinic of patients to see, despite the pit in my stomach, and despite the whole world changing for my last patient. No rest for the weary in medicine.

It’s both different and the same for practitioners in any specialty. For an ER provider, it may be the third code blue in as many hours. For a trauma provider, perhaps a fatal motor vehicle collision at the hands of an impaired driver. For an ICU provider, it might be discussing terminal extubation. Or for a family practice provider, counseling a patient that her forgetfulness is a symptom of something serious.

So what do you do? The best you can do, as always. When you’re with your patient, speak with compassion and empathy, but also honesty. Talk to your patients like you would want someone to talk to you, or to your parent, sibling, or friend. Afterwards, decompress. Take a deep breath. Take a short walk. After the craziness of the day, talk to your spouse, your best friend, your colleagues. Seek out support offered by your hospital or organization. Most importantly, don’t lie to yourself about your emotional invincibility. Do you know that healthcare provider who is always extremely compassionate but yet never lets anything get to him or her, ever? Me neither. It’s a myth.

There is no weakness in seeking support from your colleagues and loved ones. And you’re not flawed if occasionally your work follows you home. When I was lamenting a particularly tough day delivering particularly bad news, my husband said “I know it’s hard, but I’m glad it was you.” On seeing my puzzled look, he expounded: “If I had to get news like that, I would want it from someone who cares, even if it’s tough.” We’re all here to support our patients, and just as importantly, each other. In health care, we work as a team. Let’s do our best to take care of our teammates. In the world of medicine and beyond, we do our best, and we get by with a little help from our friends.

In the comment section below, please share any tough experiences you’ve had as a healthcare provider, or, if you are a student, perhaps any fears you have about handling situations like this in the future. Let’s start a dialogue so that we can better support our colleagues and ourselves.

 

 

Register Now for more NEJM Journal Watch Content

14 Responses to “When Medicine Is Hard”

  1. Marty Tetlow says:

    Powerful article.

  2. Max Voysey says:

    It may be a guy thing but I like to think that I have done my best – be it good or bad news, that’s what I can do. I (usually) did not cause the patient’s problem – and more often than not they did ( I don’t rub that in).I try to stick with facts – later sessions can be about my opinions. . . . .and our community can be, but is not always, helpful. I know dying is bad – but try telling the 45 yr old mother after 5 years of IVF that her one year old is probably autistic usually ruins everyone’s day – for the rest of their long lives. . . .

    • Megan Tetlow says:

      Dear Max,

      Thank you for comments. Great point, I think sticking to facts and not speculating beyond exactly what you know is so important. And in regards to your example, that is certainly very emotional news to have to deliver to a family. That’s why I think it’s so important to have these types of discussions among fellow healthcare providers, so that we can see that we’re not alone in having to have these difficult conversations. You don’t need to work in a certain specialty or be dealing with a patient with a terminal illness to experience the emotional consequences of being integrally involved in human tragedy on a routine basis.

      Sincerely,
      Megan Tetlow

  3. Chanel Robinson says:

    Thank you for this. A wise and experienced Physician said this to me once: ” As a dr there will be times that you don’t get to be the Magician. That’s ok – as long as you get to be the Magic”. Kindness – it takes the edge off reality xxx

  4. Very good article. I remember several difficult moments and times in my Oncology career. I believe that we all can help, if not cure or heal so to say. It is especially difficult to watch the teen agers and children suffer and succumb. It is also rewarding to watch them beat the odds and emerge victorious.

    • Megan Tetlow says:

      Dear Dr Shenoy,

      Thank you for your comments. And I completely agree with you that yes especially in those times of hardships, it’s likely even more important to remember how great it feels when the pendulum swings the other way so to speak, and we have patients that beat the odds, and overcome immeasurable struggles, and just soar. Thank you for that reminder.

      Very sincerely,
      Megan

  5. Elena Bressanin says:

    Thank you Megan, your article is very touching. Every physician should read it: all of us someday need to cope with the feelings you described and would take comfort from words like these. I’m sure your gentle heart makes you a wonderful doctor.

  6. Simone says:

    Dear Megan
    Thank you for this blog. You are spot on of course. As health care providers ‘we take an emotional beating’ regularly and feel that we are expected to suck it up. In the Netherlands they have started a mentor system: specialists have a ‘mentor’, i.e. a colleague to discuss difficult situations with. Sadly I do not work there any more and have struggled in the past not finding support with colleagues. I now work in a wonderful environment where we do support each other when necessary. We can’t change our jobs (and wouldn’t!) but we can be kind to our colleagues in difficult situations. (I’m an obstetrician/gynaecologist dealing with loss etc all the time and sadly experienced it myself so have certainly learned to recognise what other women need and to keep my eyes open for the difficulties doctors and nurses face).
    All the best from Australia

    • Megan Tetlow says:

      Dear Simone,

      Thank you so much for sharing. And what a wonderful idea to have a mentor/buddy system so that you have an established person to discuss these difficult situations with instead of having to seek out someone. I think that would be a great benefit for providers in a mutlitude of specalities and healthcare systems

      Very sincerely,
      Megan

  7. Cortney says:

    Megan- thanks for your post. As a fellow PA in oncology I can relate well to your feelings and struggles. There are days when I can make it through giving some bad news, and then some good news and then just come home and go about life. Then there are days where that one patient-that one appointment- can make you really feel the gravity of the things we tell people daily. Sometimes it’s that tear I didn’t expect to see roll down a patients cheek, or that thank you and appreciation they show even when I’ve flipped their world upside down that reminds me: we are all human and life is hard, sometimes it just plain sucks. It’s those days that reflecting on why I chose this path is most important; it’s those days I come home hug my husband, cry on his shoulder and call my parents to tell them I love them. It’s those days I drag myself to yoga to breathe through the stress and refresh so I’m ready when the next patient needs me.

  8. Wale says:

    Great article. What has been your experience working in England as a PA?

  9. Ron Knight says:

    The one thing you should never say is that there is no more you can do. You must show the patient that you are still on their side and will do your very best to help them even though you cannot cure them.

Leave a Reply

Note: This is a moderated forum. By clicking on the "Submit Comment" button below, you agree to abide by the NEJM Journal Watch Terms of Use.

Our physician bloggers cannot respond to requests for personal medical advice, and recommend patients discuss health issues with their individual physicians.

NP/PA Bloggers

NP/PA Bloggers

Bianca Belcher, MPH, PA‑C
Elizabeth Donahue, RN, MSN, NP‑C
Alexandra Godfrey, BSc PT, MS PA‑C
Emily F. Moore, RN, MSN, CPNP‑PC, CCRN
Harrison Reed, PA‑C

Advanced practice clinicians treating patients in a variety of settings and specialties

Learn more about In Practice.