This was initially meant as a submission to the Gold Foundation. I submitted it to their essay contest on what it means to be a good doctor, on time, but with a blank entry sheet so it was never considered. Clearly, I’m a genius. The title is inspired partially at least by my obsession with the Big Bang Theory. Enjoy!
The Goldilocks Conundrum
When I told people I was going to med school, the first thing I’d hear was “oh, you’ll be a good doctor”. As an idealistic and energetic first year I was flattered every time a standardized patient said that I came across as a good doctor-to-be. Of course, I wasn’t a good doctor- primarily because I wasn’t a doctor. My exposure was to esoteric subjects like biochemistry and physiology- I wasn’t much good to any person in distress. Like my classmates I believed I was going to be a great doctor- all that was missing was clinical knowledge, clinical acumen, and experience.
Now, as a second year med student with almost all of my classroom experiences behind me, I’ve developed a degree of clinical acumen and clinical knowledge. I’m still lacking in detail, and I often mistake horses for zebras- like the time I made a diagnosis of possible Ebola virus in a patient with bloody diarrhea. It turned out to be Salmonella from bad chicken. But, I figure, once I’ve studied up my First Aid and learnt the theory of medicine, I’ll be a good physician. The question remains, who or what is a good physician?
As a naïve newcomer to medicine, I believed a good doctor was someone who not only knew the medicine and the art of diagnosis, but also deeply cared for and was invested in each patient’s prognosis and care. A good physician would put his or her all into a patient, and if the patient didn’t make it, would feel sadness at their loss, yet that physician would get up and do it all over again, a dozen times a day. And at the end of the day, they’d go home and see their loving, caring family and be well adjusted parents and spouses.
Now, I’ve come to believe that image of a good doctor in my mind is flawed. If I’m too invested in my patients, chances are, I’ll become an impaired physician. If that happens, I’ll probably be an alcoholic, or start abusing drugs misbegotten from my own prescription pad in order to forget the people I couldn’t save, the mistakes I made. If I spiral down that path, I’ll likely cause damage the whole way down- to family, friends, and perhaps even patients.
The other path, the one which many doctors take, is detachment. I can choose to look at my patients like bags of organs, with a dysfunction that I can repair or replace. If something fails, if they don’t make it, I can insulate myself enough to not be truly hurt. In this case, I’ll protect myself from self-destructing and perhaps even accrue wealth, prestige and power. The downside is, I won’t be practicing medicine for the reason I went into it. Instead, I’d be functioning as an automaton and a machine- which should be anathema to a physician.
If I were to truly be a good doctor, I’d have to be like Goldilocks. Just right. I can’t be a callous, uncaring person who sees patients as bags of enzymes and organs. Nor can I be completely invested in and care about every patient who sits in my exam room, or haunted by my failures. I need to be able to care about my work, and care for the people who need me, but also be able to let go. I need to be able to separate home from work, and to keep my family safe from my professional demons. I need to be able to go home at night, and let go of the day’s travails and sleep without being haunted. Yet my failures need to inform me, to teach me as a physician, and as a human being.
That’s a nearly impossible standard, especially since we don’t talk about it as a profession. We don’t discuss how to let go- we don’t discuss how in Rudyard Kipling’s words to allow “all men count with you, but none too much”. We are taught everything about medicine, except to express and deal with our feelings. We keep them bottled up inside, unexamined somewhere deep in our psyche. Expressing our doubts, our feelings, our weaknesses is frowned upon, or seen as touchy-feely and weak. So, we repress our feelings and our demons, exorcising them if we must with alcohol and drugs.
A good physician? I’ve seen some of those. I’ve seen physicians who can stand in front of a crowd of medical students and talk about what gives them strength, what keeps them going, their challenges and the pain they’ve felt, and how they got over them. One, a doctor who works in the trenches in the Emergency Room spoke about how every day, he sees people who are terrified, afraid and often having the worst day of their lives. And that his job is to make their worst day a little bit better, a little bit more bearable. He spoke about the cost, about the difficulty of separating work from home, about the losses and failures that haunted him but how every day when he walked into his house and saw his daughter’s eyes, his demons were banished.
The practice of medicine is a truly human profession- flawed, challenging, inspiring and infused with the sadness of mortality and the fear of futility. To practice that art well, may be one of the toughest things in the world. But, if my mentor’s words are true that challenge may also end up being the most fulfilling thing in my life. I’m not a good physician yet, and not just because I’ve not received my MD. I’m still learning, still finding my humanity. That’s a process, a long road I may walk every day of my professional career. So I start my search for the perfect temperature porridge, warm enough to be compassionate, cool enough to remain objective.