The art of medicine

There are some things that other doctors look for when they want to find a good doctor. And it's not that guy that bitches about his patients and has MD on his checks and credit cards and on his vanity license plate.

When I'm looking at other doctors, I'm looking for that guy who loves the pathology. He gets excited about hypertension. He dreams of gallbladders. He can give a 20 minute impromptu lecture on nephrolithiasis. He knows his shit and he knows it because he loves it.

He fears the white coat. He doesn't splash his doctor title around like a piece of fancy jewelry. He respects the meaning of it, what it means to patients. Just being a doctor means a lot, a fucking lot, to people and he takes that responsibility seriously.

But I think most importantly, he understands that there's a science to medicine, and then there's an art. Science is all about data and studies and biochemical markers, and that stuff is great. Fantastic. But the thing about medicine is that you don't treat test tubes and beakers. You treat people. And in any field where you work intimately with people's lives, there's an art to it far above what science can offer.

Because there's no textbook on how to deal with that confrontational patient who's fighting your every move because she's lost complete control of her life and she's grasping for any amount of control that she can get, even if it's refusing her morning labs. There's no multiple choice test that will teach you when a 96y/o demented lady should get a PEG tube and when she needs Hospice. There's no lecture that can prepare you for telling a patient's family that he's going to die, not in a month or a week or a couple years but today, this afternoon.

After I did my first family meeting where I was the doctor, I was the one delivering the bad news, I grew up that day. Understanding the biochemical mechanism of neosynephrine doesn't make it easier to tell some poor lady's husband that it's the only thing keeping her alive.

And I sat there for what seemed like 10 minutes, not saying a word, letting the patient's family cry and sob, letting them grieve, and I knew that 12 months before, I would've blabbered on incessantly, but that day, a voice inside my head said, "Shut the hell up. There's nothing you can say that will somehow make death more palatable."

And so I offered tissues and a shoulder to cry on, and I had the nurse titrate off the levophed and neo. And I'll be damned if I didn't feel like a doctor that day. Because any idiot can read the studies and order the tests, but there's no randomized, double-blind, placebo-controlled study that can teach you how to be a caring human being. And sometimes that hurts, but it's a good hurt.

And the only word of caution I offer is this: at some point, you will realize that you've nothing left to give. You've poured yourself empty. And that's good, because it's then that you'll realize that you're not in the practice of medicine to give yourself. You give medicine. That's the art.


xyz said...

Hey, I just started reading your blog, and I would just like to say that this is an incredible post, probably my favorite and the one that hits home the hardest.

I am a biological engineering major in university and I am heavily considering medicine (along with investment banking). These posts are really helping me decide (they're actually making it more complicated because there are more things to consider).

But yeah, again, great writing.

Anonymous said...

To Vanish - most people dislike unsolicited advice, but as someone who went into investment banking after graduation and now works in healthcare, I highly recommend talking to as many people as possible, both bankers and doctors, and interning in both fields. Whichever you end up choosing I guarantee you the experience of internships and informational interviews won't go to waste. Good luck.

Rathnashikamani said...

Very informative blog.