Can you ever really help someone?

[cjmurph14]

I'm really not trying to be dramatic here. Yes, I know that physicians help people. I guess I'm asking, do physicians or med students find that the reality of "helping people," whatever that means, does not quite match up what the expectations were? I understand that many of us students go through the curriculum with an inflated sense of this idea, but how inflated is it?
I'm shadowing a physician that I think does incredible work on a daily basis, but finds himself frustrated in the day-to-day or no longer is captivated by the work he does. He told me at one point, and this is a poorly summarized quote, "Go into cosmetics and get paid upfront or find a side gig because the work gets harder and the money you get for it gets smaller. Don't be like me and go into it being naïve believing you can help people because you can't." Now this physician is an ortho, has relatively well patients and significantly helps his patients get back to a way of life they had/want. I don't quite understand how he is unable to see the value that his practice provides. I'm not claiming to know all of the aspects of his life that may contribute to his outlook, but the results of his practice appear fairly tangible.
So I'm just wondering, where do physicians lose this idea that you can help someone? Did they once believe it when they started school and found that the reality wasn't there once they get into practice or do they slowly fade into the cynicism that no one really wants to take control of their health? Maybe they get disenchanted when they find that medicine is about the business so much more than about the treatment? I'm sure I'm generalizing all over the place here, but I just would like to know if this is a future I should be anticipating for myself.

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[Ganon]

When you really break down the NNH vs NNT for most of our primary care standards of care, you realize how we often build cornerstones of care out of slight improvements in outcomes in a handful of patients. The vast majority receive little benefit from most of it, and that's hard to swallow.

I will say this, though: Working in medicine put me in the path of interacting with people who truly needed someone. Often the needs blended medical and psychosocial. When those opportunities come up, it's a real chance to make a difference that is tangible and truly helps someone. It isn't every day, but it happens. When I'm feeling down, I hold a folder of letters from patients/patients' families, and it's a huge encouragement.

This is one of those times when we have to skew a bit from the hard science and get into the squishy human stuff, but... That's my opinion as an RN and MS4.

 

[Cornfed101]

It’s a little bit of both the actual difference you’re making for patients and the outlook of the physician. There are some specialties that typically have better outlooks than others. My dad is an ophthalmologist and one of his favorite things about his speciality is that cataract surgery is nothing short of a miracle and he can create a complete change in someone’s quality of life in just a few minutes. Not all specialties allow for that, but some definitely do

 

[Kardio]

I expect that much of the benefit is only visible in statistical changes in populations; you can administer a covid vaccine, but you can’t see the patient *not* get covid

 

[Matthew9Thirtyfive]

I expect that much of the benefit is only visible in statistical changes in populations; you can administer a covid vaccine, but you can’t see the patient *not* get covid

Bone broke. Bone fixed.

 

[nowanmd]

wait until you run a succesful code, wait to hear hear stridor, order a chest xray and find a lymphoma or pick up pancreatic cancer after a work up for a dulated pancreatic duct seen on an ultrasound exam. You will help people, sometimes dramatically, sometimes by treating diabetes or heart failure. Admittedly, there is alot of drudgery and hard work. Howver after more than 20 years I know I have helped many people, even if they don't know it.

 

[Miles Gloriosus]

Bone broke. Bone fixed.

It’s not that simplistic. You can fix broken bone anatomic but there is always a subset of patients that never seem to get better no matter what you do. I imagine that the OPs doc is beat down by the handful of patients that he thought he did everything right but still for some reason have a bad outcome. It only takes 1-2 of these patients a clinic to ruin your entire day to make you forget the 30 patients who are happy.

 

[FalconSlice]

It’s not that simplistic. You can fix broken bone anatomic but there is always a subset of patients that never seem to get better no matter what you do. I imagine that the OPs doc is beat down by the handful of patients that he thought he did everything right but still for some reason have a bad outcome. It only takes 1-2 of these patients a clinic to ruin your entire day to make you forget the 30 patients who are happy.

Rule #1: Gomers don't die

 

[Matthew9Thirtyfive]

It’s not that simplistic. You can fix broken bone anatomic but there is always a subset of patients that never seem to get better no matter what you do. I imagine that the OPs doc is beat down by the handful of patients that he thought he did everything right but still for some reason have a bad outcome. It only takes 1-2 of these patients a clinic to ruin your entire day to make you forget the 30 patients who are happy.

I was responding to the concept that seeing benefit is mostly on the population level since you can’t see a patient not get sick. It’s not that way for every specialty.

 

[Chads2]

Once, I administered comfort care to a dying 80-something year old lady. Her 60-something year old daughter thanked me for helping her mother not be in pain, and sent me a thank you card afterward.

There are many for whom you practice great advanced medicine who don’t feel helped...but sometimes you help patients even without advanced medicine.

 

[MickyMeowMeow]

I think it depends on who you compare to, what you want, and the situation in which the doc said that.

It's work stress-induced manifestation of greed and fear (i.e. mixed emotions).

If we dissect your description...

"Go into cosmetics and get paid upfront" reflects greed for more income and less hassle; comparison to the other specialty.
"or find a side gig because the work gets harder" reflects fear of increased demand from new regulation, and updates...etc.
"and the money you get for it gets smaller." reflects fear of income reduction.
"Don't be like me and go into it being naïve believing you can help people because you can't." reflects a sense of embarrassment that the emotions going on in the mind have nothing to do with "helping others," the initial intent, which the doc is reminded of because of being with you.

This reflective process happens so often in other careers and daily living, too.

 

[Lem0nz]

I mean. I cut cancer out with my hands.

Or a robot. Beep boop surgeon go brr.

 

[oldman]

I'm really not trying to be dramatic here. Yes, I know that physicians help people. I guess I'm asking, do physicians or med students find that the reality of "helping people," whatever that means, does not quite match up what the expectations were? I understand that many of us students go through the curriculum with an inflated sense of this idea, but how inflated is it?
I'm shadowing a physician that I think does incredible work on a daily basis, but finds himself frustrated in the day-to-day or no longer is captivated by the work he does. He told me at one point, and this is a poorly summarized quote, "Go into cosmetics and get paid upfront or find a side gig because the work gets harder and the money you get for it gets smaller. Don't be like me and go into it being naïve believing you can help people because you can't." Now this physician is an ortho, has relatively well patients and significantly helps his patients get back to a way of life they had/want. I don't quite understand how he is unable to see the value that his practice provides. I'm not claiming to know all of the aspects of his life that may contribute to his outlook, but the results of his practice appear fairly tangible.
So I'm just wondering, where do physicians lose this idea that you can help someone? Did they once believe it when they started school and found that the reality wasn't there once they get into practice or do they slowly fade into the cynicism that no one really wants to take control of their health? Maybe they get disenchanted when they find that medicine is about the business so much more than about the treatment? I'm sure I'm generalizing all over the place here, but I just would like to know if this is a future I should be anticipating for myself.

The key to medicine is to look at the concept always of goals of care. What we feel is helping a patient can be very different from what a patient views as being helped. Sometimes the patients themselves don't think about what they want until you ask them. Someone with cancer at first will probably want the cancer removed. But perhaps better to understand why someone would want aggressive or not aggressive therapy. I took care of someone with advanced cancer that was hopeless to do more treatment. She persisted in wanting treatment that had a low chance of prolonging her life, but when questioned further the goal was to try to last a few more months to see her child graduate from college.

 

[Doctor-S]

I'm really not trying to be dramatic here. Yes, I know that physicians help people. I guess I'm asking, do physicians or med students find that the reality of "helping people," whatever that means, does not quite match up what the expectations were? I understand that many of us students go through the curriculum with an inflated sense of this idea, but how inflated is it?
I'm shadowing a physician that I think does incredible work on a daily basis, but finds himself frustrated in the day-to-day or no longer is captivated by the work he does. He told me at one point, and this is a poorly summarized quote, "Go into cosmetics and get paid upfront or find a side gig because the work gets harder and the money you get for it gets smaller. Don't be like me and go into it being naïve believing you can help people because you can't." Now this physician is an ortho, has relatively well patients and significantly helps his patients get back to a way of life they had/want. I don't quite understand how he is unable to see the value that his practice provides. I'm not claiming to know all of the aspects of his life that may contribute to his outlook, but the results of his practice appear fairly tangible.
So I'm just wondering, where do physicians lose this idea that you can help someone? Did they once believe it when they started school and found that the reality wasn't there once they get into practice or do they slowly fade into the cynicism that no one really wants to take control of their health? Maybe they get disenchanted when they find that medicine is about the business so much more than about the treatment? I'm sure I'm generalizing all over the place here, but I just would like to know if this is a future I should be anticipating for myself.

So ... you're shadowing one ortho out of 1000's of orthos; and other docs definitely have differing opinions.

My comments:

1. Some patients choose to not help themselves - and that's their choice. Same thing for you when you consult with a doc, eh? Plus, some patients choose to be non-compliant despite the best medical advice. Based on my experiences, many patients DO choose to help themselves because they don't want to be in pain, or ill, or incapacitated. Docs can (and do) educate and help patients who want to help themselves. Sometimes, the outcome will be positive (and docs will feel good about things); and other times, it will not be so positive (and some docs may feel discouraged about things). I get it. That's the everyday practice of medicine; and that is one of the things you should be observing and experiencing when you shadow different docs.

2. Modern medicine includes lots of business and tedious admin stuff as well as diagnostic, patient-side clinical stuff. Docs deliver medical care and treatment to patients. They're compensated for those professional services. You can retain individuals who are qualified to manage the business side of medicine - or cmgs will do that for you. Some matters will be stress-free; and other matters will be stressful. Overall, it's manageable and you and your staff will learn how to resolve various matters, as needed, and as a team.

Sending good thoughts to you and wishing you the very best of success in your future medical career!

 

[ACSurgeon]

I mean. I cut cancer out with my hands.

Or a robot. Beep boop surgeon go brr.

Then the cancer comes back. Is that really helping?

 

[ACSurgeon]

a lot of job dissatisfaction come from external factors to the practice of medicine (e.g. admin, politics of medicine). It’s easy to associate job dissatisfaction with feeling like you’re not making a difference. I’m sure for some people the job dissatisfaction comes from bad financial planning or unrealistic financial expectations.

otherwise by definition the physicians job is to help people in a variety of ways and settings. I can understand burning out from the increasing acuity, medical train recks that have now become “average”, and delivering healthcare treatments to patients in their last six months of life who you know have little to know chance of a meaningful recovery. All that aside, The vast majority of what any physician does is to help people. Even the cancer doctors

 

[Lem0nz]

Then the cancer comes back. Is that really helping?

I think so. Even when it comes back I’m seeing most of my patients live much longer than what the books tell me they should. Sarcoma’s that you would expect 6-12 months, generally getting 2-3 years of longevity with aggressive treatment and their quality of life, particular in the younger ones, is still really excellent. The pancreas cancers seem to be living longer too. The colon cancers definitely, that’s a chronic disease of whack a mole at this point.

So. Yea, I think we are even when it comes back. And it doesn’t always come back.

 

[ArteryStudyPainting]

"You Gotta Accept That Everything We Do Here, Everything, Is A Stall." - Dr. Cox​

Question becomes: was the stall worth it? To the 100 year old? Maybe not. Then you'd be right, sure.

To the 20, 30, 45, 65 year old with treatable cancer? Plenty of life left to live there, if, they want it.

 

[InternistDO]

I think some doctors forget the mundane nature of a lot of lifesaving medicine. Giving ceftriaxone and azithromycin to a borderline septic 65 year old with pneumonia is probably saving their life. But dang, its a boring admission--fluids, a few days of oxygen and antibiotics and bye bye, all done. So we feel like "anyone" could have done it and so it doesn't feel that impressive.

But even considering that, oncologists cure cancer in young patients and have them live for 40 more years. Cardiologists cath STEMIs and save a cardiogenic shock peri-arrest patient and let them go home to their kids. HIV physicians have turned a disease that was 100% lethal to one that doesn't even change your life expectancy. It's less flashy, but if you control a patient's A1c and BP as their PCP you probably are adding a decade of disease free years to their life.

Yes, it's frustrating when patient's don't take their medicines and do poorly, or when you have a bad surgical outcome, or when you try your best and the patient dies anyway. But to say that modern medicine doesn't save people every day is crazy.