October 10th, 2005
Seven A1s doesn’t make you a Doctor
After my last post, it seems I’m disillusioned with Irish medicine. From boardroom ethics to verbal arrogance, it seems the medical profession still has much to learn in this country when it comes to sensitivity to patients and their families.
This day last week, a woman I know was told some very bad news. Her 20 year old son had recently been having serious problems with one of his organs and had had several operations over the last few weeks. Last week as he lay unconscious on a ventilator and was being intravenously fed, his mother was told that he had 24-48 hours to live. If that’s not heart-breaking enough, the manner in which the news was communicated to her compounded the horror of the situation. The doctor was so offhand and aloof in telling her some of the worst news she is ever likely to receive, that she could barely believe the news and the tone in which it was delivered. There was no compassion, no sensitivity, just a blunt statement as if he were merely deciding on a new course of treatment. Tragically, the boy died and so my weekend has been spent seeing relatives and at the funeral.
When I was in my early teens I had a series of hip operations, culminating in one that required a large, cumbersome plaster called a hip spika. It covers more than half your body and after a big operation and nine weeks in this plaster prison, it was time for it to come off. One of the orthopaedic team duly arrived with a plaster saw, revved it up and started to tackle the plaster. My mother was with me, and after a few minutes, I told the doctor that I could feel the saw cutting my skin. He stopped, said nothing for a few minutes and resumed his task. After a minute of agony, I couldn’t stand the pain and again intimated that I was sure the saw cutting me. The doctor, expressionless and indifferent, explained that this saw was incapable of penetrating skin because of its design. We continued. More pain and much shouting from me. At this point my mother asked him to stop as I was distressed and she was upset. He told me I was overreacting and shouted at my mother to leave the room because he she upsetting me further. My mother refused and he subjected her to a shouty lecture before storming off. The next day, I was brought to the operating theatre where the plaster was removed under anaesthetic. When I woke up, it looked like a psychotic craft class had gone at my legs with a pinking shears. Later that day when the orthopaedic team arrived for some post-plaster analysis, the doctor in question skulked at the back of the room while my surgeon apologised for what happened. I didn’t do anything about it, even though I still have four two inch non-operation scars my legs thanks to a doctor who wouldn’t even catch my eye, let alone apologise for the Texas Chainsaw job on my legs.
My last experience of hospital is a better one and I can’t find fault with the wonderful haematology team who treated my leukaemia (except for the one whippersnapper psychologist who wanted to give me Prozac after coming off a continuous morphine pump for my lungs after two weeks. Apart from the fact that I was on about 30 different drugs, I was only feeling as mad as a bag of spiders because of the withdrawal). The nurses and haemotologists were amazing, especially given the amount of care required when you’re that sick.
My point is simply this. Being a science whiz or clocking up the maximum seven A1s in the Leaving Cert doesn’t make you a doctor. A huge part of medicine and dealing with sick people is compassion. Being a medical genius is fine but if you don’t have the people skills and an acumen for sensitivity, you shouldn’t be a doctor. It can be learned in the context of medicine and it is as fundamental to being a doctor as prescribing drugs and diagnosing illness.
October 10th, 2005 at 4:42 pm
Couldn’t agree with you more, Sinead.
I know a lot of people in the medical profession and have been surrounded by them all my life being a doctor’s daughter;but, the one thing that strikes me about medicine is that is must be a vocation. I think the education system in this country has a lot to answer for. Students desperately try and deal with the stress of clocking up massive points in the madness that becomes the annual points race. And once you get all these points, what are you going to do with them? The choice is simple - is it law or medicine?
In my college days I knew a few students who, by virtue of their leaving cert tally alone, chose medicine. These two were braver than most and realised before it was too late that this was not for them and changed to english and history. Our students are simply not encouraged to choose a path that’s right for them, but constantly pushed towards high points courses resulting in high salaries, because it is the greatest badge of so-called respectability.
There are some excellent doctors out there; and, you are right when you say that the job demands sensitivity and compassion. But in the go-getting, self focused society that has emerged in Ireland recently, it is hardly surprising that for every really great doctor, there are ten or more who are just in it for the money; for the extortionate consultant’s fees and the chance to fit their careers in around eighteen holes.
October 10th, 2005 at 8:49 pm
You are absolutely spot on here and I feel terrible for the grieving mother.
i’ve been living in the US for over ten years and during this time have often pondered why we Irish (and Europeans in general) accord so much deference to doctors and lawyers. Here in the US, the attitude is that they are paid to HELP us, and they are owed nothing but respect and courtesy. Neither a law or medical degree entitle these people to treat their patients or clients in a condescending or disrespectful manner. People’s subservience to Irish professionals is a throw back to the Bristish class system, I suspect. Americans never had that sort of system and being a lawyer or doctor is no better or prestigious than many other careers. I practiced law over here and I got a weekly wage just like any other worker. What’s more, i wasn’t treated like I was above anyone else and appreciated that, quite frankly. I appreciated when a client treated me as an equal, albeit an equal whom he knew had legal knowledge that he or she required.
Moreover, in the US, doctors and lawyers are FULLY accountable, which is more than I can say for solicitors, barristers and doctors back home. i think reforms and a change of attitude are overdue in Ireland and elsewhere in Europe.
October 11th, 2005 at 11:06 am
It is a bit of a cliche, but that old “god complex” is possibly partly to blame for the attitude.
Isn’t there supposed to be a change in the way we qualify doctors though? A conversion course of some description. Not sure if it is just in the “talking about it” stage or the “maybe we’ll implement it at some point in time” stage.
October 12th, 2005 at 12:01 am
I know a lot of the current batch of graduates, and on the basis of those I am fortunate enough to know, perhaps there is hope for the future. Also, when my mother was in the final stages of her MS, the doctor who dealt with us (Ryan Tubridy’s brother, it turns out) could give lessons in bedside manner and compassion - he was straight down the line with us, very sincere and helpful, as were most of the medical professionals that dealt with Mum along the way.
That’s not to say there aren’t eejits in the profession. I had to figure out from conversations with other doctors that the redheaded nincompoop in St Vincents who decided I needed a catheter did nothing but push a kidney stone back up into my bladder.
It’s a long (and, looking back on it, funny) story that involves an over-friendly and very hands-on male nurse, some pretty poor medical skills by a nameless doctor, and plastic tubing of an uncomfortable diameter.
Sadly, his communication skills matched his practical knowledge.
November 6th, 2005 at 5:10 pm
I’m so sorry that you’ve had such dreadful experiences with the medical profession.
I’m currently a few months away from becoming a doctor and am struggling to accept the fact that 5 years have passed since I clutched my As and entered medicine. I’m one of those people who did medicine “because she could”. It was a toss up between theoretical physics and medicine in TCD and got the medicine so away I went to get a dissection kit and a white coat.
People skills and bedside manner is taught to us in the helpful “role play” format which is a complete waste of time. After 6 years, my youthful idealism and belief in the self sacrificing profession of healers has been tarnished slightly, but has not waned. I’ve watched doctors tell parents of 26week old twins that they have died in utero, tell a 24 year old woman that her incredibly rare breat cancer has returned and that’s there no real cure with compassion and genuine concern for the fellow human being in front of them. Unfortunately I’ve also watched doctors strip off surgical bandages on ward rounds without pulling the curtains and watched helplessly on an A&E ward round as one woman tried to explain her alcoholism in full view of the world and its mother lying around her.
While it’s an easy thing to blame, working hours do play a huge part in how doctors treat their patients. If you’ve been on the trot for 24 hours looking at the same thing over and over again and struggling to keep your eyes open with coffee dreading the ward round where your consultant will expect you to be up to date with all your patients - a simple smile becomes very hard.
There will always be bad eggs in every profession but what to do to change this culture? Changing the entry process won’t help much - interviews will pick just those who can talk about compassion, not neccesarily practice it and you can’t teach someone what to do in terms of a written protocols.
The basis of this problem and the only real solution involve an increasing appreciation for the human dignity inherent in every person and continually striving to recognise and honour it in every patient you meet.
(Apologies for bit of a rat - got a little carried away!)
November 7th, 2005 at 12:37 pm
I totally agree with you Auds, each profession has its share of bad folk, but it’s just so important to recognise that there are so many factors that contribute to being a good doctor. I can only imagine your ability is also diminshed somewhat by the unacceptable hours that young doctors are forced to work.
Reading your post, I was reminded of someone I went to school with who chose medicine. Very smart, lovely person, but cripplingly shy and as a result, a very inept communicator. Doctors need to be able to communicate, not just inform, and I’m at a loss to figure out how something so innate can be taught (and at the same time infused with real compassion).
It sounds like you’re already well aware of the importance of patient/doctor dialogue which is very heartening so best of luck with your career as a doctor.