Self-Help

We began the day yesterday with a talk from a family physician -- class of 2003, so just 7 years ahead of us -- who in his first year of residency was suddenly struck with a bizarre, unpredictable and uncharacterized seizure disorder. It initially hospitalized him for 8 days in a largely unresponsive state...after that it kept him from participating in his training, plunged him into a major depression, and interefered with his home and social life. He talked about everything, from the big things -- not knowing if you're going to lose control of your own body any second -- to the littler things -- the awkwardness and embarrassment that results from being brought into the ER in front of all of your colleagues and friends.

He didn't present himself as an abstract case for diagnosis, but as someone to whom we could relate. This is a guy who spent his life preparing to help others, as we all have. What do you do when suddenly, it's you that needs the help? He talked about how few doctors actually protect their health, or go in for help when they need it (physically or mentally)...they tend to minimize their symptoms, self-diagnose, and (most frighteningly) prescribe medications for themselves. The message here, I guess, was to remind us that we're not a separate entity from our patients. We have as much need for care and medical help as they do. And when we forget this, we run into territory that might be hazardous to us.

I guess this is one of the many "conflicting messages" I've been perceiving, even in the first few days of medical training. (I guess it's my job to harmonize them over the next few years, and that's fine.) But I think it is easy to think of ourselves, physicians and physicians-in-training, as a group apart. There are so many factors that contribute to this. We wear white coats. And stethoscopes. Already, in first year. We are told to be professional -- uber-professional -- that our codes of conduct are strict and numerous. And we learn things, dark and secret things, about the human body that no one else knows -- things we're encouraged to keep within our own tiny academic context. Other physicians? They're our colleagues, our friends -- people who take care of other people WITH us, not people who take care of us. How can we go to a colleague and submit to their judgment? How can we put ourselves in the position of our patients?

Already, I can tell we're separating ourselves -- I can tell from the vocabulary of our lecturers, from the vocabulary of my classmates, from my own vocabulary. It's becoming an us-and-them relationship already. Sure, there are all the usual platitudes about "seeing your patient as a whole person". But that implies that there's a danger that you won't -- that you have to do something special to see your patients on the same level as anyone else you encounter. On the same level as yourself. As someone in a position that you could potentially be in, at any moment.

I don't know how much of this is inevitable and how much of this is dangerous. I feel like I'd be damaging myself if I allowed this to happen. Then again, I'm not sure that asking for help from peers has ever been particularly easy for me. It requires more thought. Like most everything.

-isolde