Recently I had the immense pleasure of being asked to co-teach a class at the David Geffen School of Medicine at UCLA. The course is a requirement for first year medical students, and it is called “Doctoring 1”. The medical school puts a tremendous amount of effort into this course, which teaches many things including how to deliver bad news, how to interview a patient thoughtfully and without judgment, and how to encourage and counsel on healthful behaviors. When the physician who recommended me to the program spoke to me about it, he said, “it is an opportunity to remind medical students that they are human”.
Strangely enough, this made sense to me. See, I work in oncology. So I work with doctors who have chosen a very hard road in many ways. Some of them are researchers whose interest is more in the intellectual, cerebral realm than the interpersonal one. Some of them see so much suffering, they disconnect a little bit. Some of them are deeply connected and engaged. It runs the gamut, but I thought it would be useful and interesting to see what this “Doctoring 1” business was all about, and how it contributes to the development of young medical students.
There’s no one-size-fits-all of doctors and patients. When I am working with a patient who has personal differences with their doctor, but believes them to be highly skilled and the best fit for their illness and treatment, I remind them that their doc isn’t coming over for Thanksgiving. You don’t have to want to spend time with them or experience them as your friend. You need only to believe they will save your life.
That having been said, it’s a big deal to trust your life to someone you don’t like that much. So.
From out here it seems that medical school and residency are a lot like boot camp. From the minute a person decides they want to be a doctor, they are running to catch up. Pre-med course work is grueling. MCATs and admissions processes extremely stressful. And then they finally get in to medical school only to discover in a most concrete way that there is way more that they don’t know than that they do. Even after all that work!
The thing is, that all of this boot-camping and being put on the spot and made to spout diagnostic facts and hypotheses, is stressful. It starts to morph the “purely human” into the “purely doctor” — all chemistry and systems and diagnoses.
But I sit with people every day who say to me, “I just wish my doctor would ask how I am really feeling. And then seem like they care.” “I wish my doctor would take more time.” “I wish my doctor could say, ‘I don’t know, but we are going to try X,Y, and Z.’ Instead of pretending they know when they don’t and running me on a wild goose chase.” So I know that the human bit is important. It’s what makes the hard parts possible. Medical students aren’t really being taught to rely on their person-skills. They aren’t being asked to connect to their inherent curiosity, to ask questions from a place of honest not-knowing.
But what if we were asked to partner with our doctors and to explore and be curious together, relying on their expertise, skill and monumental training to get us there as safely as possible?
We can’t be patients without our doctors. But they can’t be doctors without us, either. It’s a two-way street.
So I have composed a letter to our future doctors, with some things I have thought of that I wish they would know. Things I hope they hold on to well beyond their first year, well into being a seasoned and wonderful professional. Things they know they can stand for and abide by, even when their preceptors are impatient, even when the attending says there is no time. There has to be time. There has to be time to be human. To connect, and make meaning, and to help patients feel seen and safe and real.
So here it is:
Dear Future Doctor,
Let me begin by saying thank you. Thank you for seeing me and for taking into account my complaints and challenges and for trying to make me feel better. You have chosen a difficult career path and I admire you. I also want to say that I trust you. If I didn’t, I wouldn’t be here. I believe that I am a partner in my healthcare and I want to feel and be better.
It is not easy for me to be sick. It makes me feel afraid and unsure. Sometimes it makes me angry. I am sorry if you feel this is personal to you. It isn’t.
Sometimes I will cry when you share something that is hard. When my life is hard. This is not the time to leave. It is the time to stay. If you have something useful to say, please do. But don’t feel like you need to or can fix or solve everything. It’s ok. Together, we can be ok. I value your expertise, and ask you to trust me, too. I ask you to trust me to process my illness, and all that it means to me. We don’t get to change the truth, but we can figure out how to react to it. That is not up to you alone. It’s my story, too.
If you do not know something, I’d rather you say you don’t know than lead me down errant paths or instill false hope. Honesty goes a long way. I don’t expect you to make my story happier by lying to me about it. I expect you to be hopeful and honest, and I know both are possible at the same time.
Whether or not you are wearing a white coat, I know and believe that you are human, and I hope that you will show me that sometimes. Humility does not equal inadequacy. Vulnerability does not equal weakness. At the end of the day, you will be the captain of the ship that is my healthcare, and I look to you for counsel and guidance, but this does not mean you can never share with me that things aren’t going as you had hoped or that things will get harder before they get easier.
The fact is, that you will walk with me sometimes through illness back to health. Sometimes, you will walk me through illness to the end of my life. I trust you to stick with me and to notice that I am afraid and there are things I still want to do and people that I love. Please help me understand how to feel good enough to be with the people I love, do some of the things I want to do, and continue to treat, if possible. But don’t let the treatment rob me of those things that I want to do with the people I want to do them with.
I know that no one becomes a doctor who is not intelligent, curious, and who wants to make the world a better place. I invite you to trust yourself in your training and as you emerge into your life as a physician. You are and always will be a very real, caring and empathetic human in doctor’s clothing. Not the other way around.
I wish you every success,
Your Future Patient