March 23rd, 2017
When Medicine Is Hard
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.