Humanistic Medicine

[Newquagmire]

Advertisement - Members don't see this ad

Is it just touchy-feely nonsense? Discuss.

On a similar note: alternative medicine. Useless?

 

[PaddyofNine]

Is it just touchy-feely nonsense? Discuss.

Um, isn't the whole point of medicine to deal with humans? Patient skills are at least as important as any other kind of clinical skills, right?

 

[Anka]

Below is a little something I wrote a while back against using 'humanistic medicine' to defend the 80 hour workweek. Here's the deal, as far as I'm concerned. Everyone wants compassionate physicians. The group of people who are most vigorously waiving the flag of humanistic medicine are doing it primarily to argue for things like shorter working hours, less stressful training, etc. But these have nothing to do with being more human or humane.

Anka

------------
I am not made more human by eight hours of sleep each night and two days off per week. Nor am I made more human by three hot, home-cooked meals per day. My humanity is not improved by going to the opera, nor diminished by being yelled at. In our efforts to create a more humane system of training physicians, I fear we have lost track of what it really is that makes us most human.

We are most human when we work to exhaustion out of love for our fellow man. We are most human when we overcome the most natural of revulsions to disimpact someone?s bowels. We are dehumanized by being forced to leave off these most humane of activities because the clock has struck a given hour, and we must go home. We are dehumanized by the implication that these most human of labors are just shift work, that we do them for money (who is it that keeps pointing out that residents make less than minimum wage?). We came to medicine to tend the sick, to comfort the dying, to improve quality of life. It takes time and energy, often more than eighty hours worth. It means that if there is no one else to take the patient down to the CT, we do it. If there is no one to get the right food for the patient, we will. As physicians, we can delegate work to the social worker or the nurse, but in the end, the responsibility is belongs to a single person, the physician. And it dehumanizes physician and patient alike to suggest that this most human of work results not from a personal connection between patient and physician, but from the abstraction of the ?health care team?, each member of which has well defined roles and quitting times, each member of which is just 'doing their job'.

 

[phoenixsupra]

Is it just touchy-feely nonsense? Discuss.

On a similar note: alternative medicine. Useless?

It may seem "touchy-feely" now. But when you encounter the culture they're trying to change it'll make sense. Medical culture is still way to far on the "paranoid android" side. As for alternative medicine, occasionally therapies get relegated from alternative to mainstream. The NIH recatagorized acupunture to mainstream two years ago. It's been studied here rigorously. We know it works. We just don't know how. Try to suspend judgement untill you get to the wards and experince the current medical culture for youself. Good luck. 🙂

 

[jessi]

Below is a little something I wrote a while back against using 'humanistic medicine' to defend the 80 hour workweek. Here's the deal, as far as I'm concerned. Everyone wants compassionate physicians. The group of people who are most vigorously waiving the flag of humanistic medicine are doing it primarily to argue for things like shorter working hours, less stressful training, etc. But these have nothing to do with being more human or humane.

Anka

------------
I am not made more human by eight hours of sleep each night and two days off per week. Nor am I made more human by three hot, home-cooked meals per day. My humanity is not improved by going to the opera, nor diminished by being yelled at. In our efforts to create a more humane system of training physicians, I fear we have lost track of what it really is that makes us most human.

We are most human when we work to exhaustion out of love for our fellow man. We are most human when we overcome the most natural of revulsions to disimpact someone?s bowels. We are dehumanized by being forced to leave off these most humane of activities because the clock has struck a given hour, and we must go home. We are dehumanized by the implication that these most human of labors are just shift work, that we do them for money (who is it that keeps pointing out that residents make less than minimum wage?). We came to medicine to tend the sick, to comfort the dying, to improve quality of life. It takes time and energy, often more than eighty hours worth. It means that if there is no one else to take the patient down to the CT, we do it. If there is no one to get the right food for the patient, we will. As physicians, we can delegate work to the social worker or the nurse, but in the end, the responsibility is belongs to a single person, the physician. And it dehumanizes physician and patient alike to suggest that this most human of work results not from a personal connection between patient and physician, but from the abstraction of the ?health care team?, each member of which has well defined roles and quitting times, each member of which is just 'doing their job'.

stop being such a martyr. when it comes down to it, doctors are only HUMAN. theyre not gods. their not robots. they have physical and emotional limits and needs that shouldn't be completely disregarded. when i'm the patient, i want a doctor who not only is dedicated to medicine, but is also connected to the world outside of the hospital, a doctor who finds happiness in helping their patients and happiness in their personal lives. in my opinion, 80 hour work weeks, chronic exhaustion, and disconnection from the world do not enhance anyone's performance as a doctor. i think it sucks the life, the passion, and the efficiency out of them. the dedication of doctors under these conditions is amazing. yes,i find them to be a cut above the rest. but whats so wrong about having a well rounded and healthy life? it may keep them more connected to the humanity they are trying to save. 🙂

 

[stomper627]

Below is a little something I wrote a while back against using 'humanistic medicine' to defend the 80 hour workweek. Here's the deal, as far as I'm concerned. Everyone wants compassionate physicians. The group of people who are most vigorously waiving the flag of humanistic medicine are doing it primarily to argue for things like shorter working hours, less stressful training, etc. But these have nothing to do with being more human or humane.

Anka

------------
I am not made more human by eight hours of sleep each night and two days off per week. Nor am I made more human by three hot, home-cooked meals per day. My humanity is not improved by going to the opera, nor diminished by being yelled at. In our efforts to create a more humane system of training physicians, I fear we have lost track of what it really is that makes us most human.

We are most human when we work to exhaustion out of love for our fellow man. We are most human when we overcome the most natural of revulsions to disimpact someone?s bowels. We are dehumanized by being forced to leave off these most humane of activities because the clock has struck a given hour, and we must go home. We are dehumanized by the implication that these most human of labors are just shift work, that we do them for money (who is it that keeps pointing out that residents make less than minimum wage?). We came to medicine to tend the sick, to comfort the dying, to improve quality of life. It takes time and energy, often more than eighty hours worth. It means that if there is no one else to take the patient down to the CT, we do it. If there is no one to get the right food for the patient, we will. As physicians, we can delegate work to the social worker or the nurse, but in the end, the responsibility is belongs to a single person, the physician. And it dehumanizes physician and patient alike to suggest that this most human of work results not from a personal connection between patient and physician, but from the abstraction of the ?health care team?, each member of which has well defined roles and quitting times, each member of which is just 'doing their job'.

Im curious to know what PGY you are....and which hospital are you in training?
stomper

 

[zeloc]

I think alternative medicine is extremely important. While we know a tremendous amount and are taught a tremendous amount in medical school, the amount we don't know still dwarfs the amount we do. Especially when you look at how other cultures treat patients.

I was recently reading about art therapy (in the US), which I think was used to help terminal patients or those with serious illnesses express themselves emotionally or something like that, and if the benefits are real and are helping people, by all means let's use them.

 

[phoenixsupra]

Below is a little something I wrote a while back against using 'humanistic medicine' to defend the 80 hour workweek. Here's the deal, as far as I'm concerned. Everyone wants compassionate physicians. The group of people who are most vigorously waiving the flag of humanistic medicine are doing it primarily to argue for things like shorter working hours, less stressful training, etc. But these have nothing to do with being more human or humane.

Anka

------------
I am not made more human by eight hours of sleep each night and two days off per week. Nor am I made more human by three hot, home-cooked meals per day. My humanity is not improved by going to the opera, nor diminished by being yelled at. In our efforts to create a more humane system of training physicians, I fear we have lost track of what it really is that makes us most human.

We are most human when we work to exhaustion out of love for our fellow man. We are most human when we overcome the most natural of revulsions to disimpact someone?s bowels. We are dehumanized by being forced to leave off these most humane of activities because the clock has struck a given hour, and we must go home. We are dehumanized by the implication that these most human of labors are just shift work, that we do them for money (who is it that keeps pointing out that residents make less than minimum wage?). We came to medicine to tend the sick, to comfort the dying, to improve quality of life. It takes time and energy, often more than eighty hours worth. It means that if there is no one else to take the patient down to the CT, we do it. If there is no one to get the right food for the patient, we will. As physicians, we can delegate work to the social worker or the nurse, but in the end, the responsibility is belongs to a single person, the physician. And it dehumanizes physician and patient alike to suggest that this most human of work results not from a personal connection between patient and physician, but from the abstraction of the ?health care team?, each member of which has well defined roles and quitting times, each member of which is just 'doing their job'.

Anka, If you think that three and a half hours of sleep or less doesn't make you less human you're just tripping. Either that or you've never done it. You're an internist, right? The 80 work week didn't come from within the profession. It was forced on us from the outside. Your 'arguement' is very abstract. Try listening to some of your patients and see what kind of doctor they want. At the end of the day they pay our salary and it's up to us to give them the sort of care they want. If you want to work more than 80 hours then do some volunteer work or something. 😉

 

[Anka]

My only experience with working >100 hours per week was working minimum wage and less than minimum wage supporting a family of three as a high school dropout. Quite different, I'm sure, than working the same hours as a resident, but it's enough to comment on the humanity of it. Sure, I didn't like it. Every waking minute was painful. People gave me a lot of **** for being a dropout and a flunky. In short, it sucked. But, here's the thing -- it didn't make me any less human.

Nowadays I get a very comfortable 8 hours of sleep every night, I work under very good conditions, I have people bending over backwards to teach me immunology or whatever it is I'm supposted to be learning, and I have a whole slew of professors wringing their hands wondering whether I'm being dehumanized. If we fail a test here, the professor is the one who gets in trouble -- all in the name of "humanistic medicine". This ain't gonna make us more human, it's going to make us whiney brats.

Working >80 hours per week doesnt' make you less human. Working <80 hours per week doesn't make you more human. It's what you get done while you're awake, and what is keeping you awake that makes you more or less human. This isn't about being a doctor, it's about being a good person. Sometimes being a good person requires you to work long hours.

Anka

 

[Spacekat]

I am not made more human by eight hours of sleep each night and two days off per week. Nor am I made more human by three hot, home-cooked meals per day. My humanity is not improved by going to the opera, nor diminished by being yelled at. In our efforts to create a more humane system of training physicians, I fear we have lost track of what it really is that makes us most human.

We are most human when we work to exhaustion out of love for our fellow man.

Jeezus, I hope I'm never your patient. When I'm lying in the ICU I don't want some underfed micro-sleeping zombie lurking around trying to insert sharp things into my body, nor do I want someone yelling at him while he does it - lack of sleep makes your startle reflex hyperactive. (Seeing as how this is the status quo, I try to stay out of hospitals.) I also don't want to be treated by someone who has nothing in his life but seeing patients - this is how genetic predisposition to psychological imbalance becomes manifest disease. What makes us human is being human, not mimicking some god-complex-toting robot.

When I worked on nuclear reactors, the kind of person you describe was the most frequent precipitator of bad accidents. We called them "glow worms."

That said, it would be possible to overshoot with the current reforms and end up with a bunch of wusses who drop out in the middle of a trauma. The pendulum has swung so hard in the zombie direction, though, that it will take an awful lot of reform to even approach such a danger.

 

[phoenixsupra]

My only experience with working >100 hours per week was working minimum wage and less than minimum wage supporting a family of three as a high school dropout. Quite different, I'm sure, than working the same hours as a resident, but it's enough to comment on the humanity of it. Sure, I didn't like it. Every waking minute was painful. People gave me a lot of **** for being a dropout and a flunky. In short, it sucked. But, here's the thing -- it didn't make me any less human.

Nowadays I get a very comfortable 8 hours of sleep every night, I work under very good conditions, I have people bending over backwards to teach me immunology or whatever it is I'm supposted to be learning, and I have a whole slew of professors wringing their hands wondering whether I'm being dehumanized. If we fail a test here, the professor is the one who gets in trouble -- all in the name of "humanistic medicine". This ain't gonna make us more human, it's going to make us whiney brats.

Working >80 hours per week doesnt' make you less human. Working <80 hours per week doesn't make you more human. It's what you get done while you're awake, and what is keeping you awake that makes you more or less human. This isn't about being a doctor, it's about being a good person. Sometimes being a good person requires you to work long hours.

Anka

Ok Anka, I see where you're coming from on this. 🙂 I've also worked many tougher jobs than the worst days in medicine and been appreciated a lot less for it. Having a working class or even lower-middle class background can make medschool sort of infuriating place. Try to drop the working class hero complex. No one will ever understand what you're talking about unless they've been there. And from a working class point of view we're all whiny brats in medschool. If you try to "tell" people they'll just think you're weird and angry. You just can't transmit that kind of knowledge with words.

I think you feel personally insulted by the notion that backbreaking labor makes people less human. Of course it doesn't. When they recharge and recuperate after work working folks are as human as anyone else. If anything the fact that you have experienced the life of the working guy probably make you more human in medicine if anything. You'll be able to relate with average folks the way more advantaged colleagues never will. While aquiring that skill is something that most doctors struggle with, you will probably have the opposite problem. You probably identify more with the poor folks than with most doctors. Your struggle will be to try and understand and not be angry about their point of view. This is no easy matter.

I agree that medschools often are sadly misguided when they try to solve this problem by proscribing literature - more education - as a cure. But the touchy-feely stuff is good in that at least it suggests that classroom-learned uptight narcissistic behaviour isn't what's needed in medicine.

So you aren't PERMANENTLY dehumanized by working a 100 hr week in any profession or trade. But you said yourself that "every waking minute was painful". Do you want to be treated by a doctor who is currently in that condition? I bet you don't. Does it matter that after some good sleep and rest he's fully human again with his family and friends? I doubt it. Our bussiness is health. If we don't possess it ourselves we can't help others achieve it. Sure, plenty if not most people work harder than doctors, for much less. Doctors are probably the only trade that get to complain about how hard they work... and people listen.... it's amazing. But this phenomenon has been around for a long long time. And it's not going away any time soon. Fighting it is about as effective as going to the seashore and fighting the tide. You need that energy to learn to understand the upper-middle class point of view if you want to get along in medicine. It'll never be your point of view but you need to understand it and make peace with it. Good luck. 🙂

 

[nicholonious]

We are dehumanized by the implication that these most human of labors are just shift work, that we do them for money (who is it that keeps pointing out that residents make less than minimum wage?).

Just being a dork, I think residents end up making $8.75/hr with the amount of hours they work. (avg salary: $35K/year, 80hr work week, 50 weeks, 50x80 = 4,000 hrs/year, 35,000/4,000 = 8.75.)

Man, that sucks, is there any way to boost resident pay? At that point in life, post-med students owe around 100K, live at home or apartment that costs 1-2K a month, food, utilities, yadda yadda....

 

[Newquagmire]

Though this discussion on sleep-deprivation is thoughtful and interesting, by "humanistic medicine" I meant the idea that being a physician means treating the person not the disease. Does our job description include more than disease?

 

[zeloc]

I was required to take many classes on this subject as an undergraduate and would be surprised if people still looked at patients as just diseases to be treated and not as people. Pretty much any sociology or social psychology class will teach the very interesting research that has been done on this area. Do other people not come from the same background? By treating your patients as people, not only will you have higher rates of compliance, but the outcomes will be better. Patients like to know that you are listening to them and not just treating them, even if it's just something like a broken leg.

 

[phoenixsupra]

Of course it does. Our job is to steer people from disease to health. Any obstical on that path is our bussiness. The word doctor means teacher after all. Now back to the interesting side discussion....j/k 😀

 

[Anka]

Okay, I totally highjacked your thread. Very few people are going to argue on a conceptual level that patients should be treated as diseases. As Phoenix has pointed out, our job is to stear the *person* back to health. Nor are a whole lot of people going to argue that physicians should be jerks. My guess is, even those physicians who are the biggest jerks never woke up one morning and said -- hey, you know, I think I'll be a jerk.

However, there's a culture, which has already been alluded to on this thread, which gradually reinforces a rather cynical view of patients. The idea behind the humanistic medicine classes, from what I can tell, is to try to counteract this before it occurs.

The question is, how are you going to do that? Right now, it's primarily by touchy feely nonsense (at least where I'm at school) -- and I don't think it'll help. We have seminar style discussions about what empathy is, and practice 'empathizing' with our patients (actually, standardized patients, which brings in a whole nuther set of issues). Empathy is a real easy thing in the abstract, it's when you're dealing with someone uncooperative, who may be angry and or violent, or vomiting on you... well, things get a little more difficult.

So, where do we learn it? I think if this is important to you [and it should be], you should identify a couple of good mentors early on who can demonstrate for you how to deal with difficult things. And I stress doing it early -- you have to take control of the socialization process, or you might not like the way you come out at the other end. The great thing about choosing your own mentors is, if this sitting in a circle and singing Kumbaya approach to being a good, personable doctor isn't your style, you can find some role models who are your style, and learn to be the doctor you want to be.

Anka

 

[Newquagmire]

No, I have never taken a single sociology course before. I am interested in hearing about this research though.

Okay, I totally highjacked your thread. Very few people are going to argue on a conceptual level that patients should be treated as diseases.

I don't mind. It was interesting to read your theory anyway. I agree that the ideal would be to feel energetic and and enthused while helping treat people without ever sleeping. But that's not possible.

Also, I am not arguing that patients should be treated as diseases. I am, however, wondering if diseases should be treated as diseases.