Not Caring about Patients

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I recently had the opportunity to shadow in the Intensive Care Unit and observe as the doctors treated a very obese man suffering from jaundice. He was experiencing kidney failure due to complications with his liver. Long story short, it was likely that the gentlemen in question was going to die.

But oddly enough, I didn't care at all either way. It also seemed as if the other doctors were ambivalent to his outcome. (One of the medical students there even checked her cell phone while assisting in a procedure).

Is this normal?

Also, this bothers me somewhat because many people mention wanting to help others as an impetus for being a doctor, but I never had that motivation. I was always more interested in the science behind disease. Is is common for doctors to be indifferent towards the outcome of their patients and does this bode ill?

 

[deleted307836]

I recently had the opportunity to shadow in the Intensive Care Unit and observe as the doctors treated a very obese man suffering from jaundice. He was experiencing kidney failure due to complications with his liver. Long story short, it was likely that the gentlemen in question was going to die.

But oddly enough, I didn't care at all either way. It also seemed as if the other doctors were ambivalent to his outcome. (One of the medical students there even checked her cell phone while assisting in a procedure).

Is this normal?

Also, this bothers me somewhat because many people mention wanting to help others as an impetus for being a doctor, but I never had that motivation. I was always more interested in the science behind disease. Is is common for doctors to be indifferent towards the outcome of their patients and does this bode ill?

I would say it is very uncommon for doctors to not give a crap whether their patients live or die. Medicine has an endpoint -- to improve the health/well-being of patients. If you aren't interested or concerned with this endpoint, why would you choose this as a career instead of a PhD?

 

[mvenus929]

It's a coping mechanism. If you invest all your energy and emotion into the outcome of a patient, you'll be going on an emotional rollercoaster that is not only exhausting, but not good for your mental health. I'd guess that they did care that he was going to die, but had long ago accepted it as an inevitability.

 

[ILikeDrugs]

I think if you're a doctor and you grieved over every patient and cared to the point where you took it home with you, you'd probably go "nuts" not to long after becoming a doctor. I think the behavior that you described would be unacceptable in front of patients and family/friends, but it really isn't something to be ashamed of as long as you don't develop a "If he dies, he dies." attitude. That might be a sign of psychological pathology in and of itself. You need to find a healthy balance right in the middle.

 

[armybound]

It's a coping mechanism. If you invest all your energy and emotion into the outcome of a patient, you'll be going on an emotional rollercoaster that is not only exhausting, but not good for your mental health. I'd guess that they did care that he was going to die, but had long ago accepted it as an inevitability.

this is true

 

[Rollo]

It's a coping mechanism. If you invest all your energy and emotion into the outcome of a patient, you'll be going on an emotional rollercoaster that is not only exhausting, but not good for your mental health. I'd guess that they did care that he was going to die, but had long ago accepted it as an inevitability.

Correct.

The challenge is to balance the "if he dies, he dies" attitude with the "my patients' well-being is top priority". A good doctor cares immensely about his patients but he should also realize which ones will die soon no matter what he does. He has to realize that he isn't God and can't play one in medicine.

I think if part of your motivation does NOT involve caring for well-being of others, then you should NOT go into medicine. All the science you will learn, years of training, mountain of debt, and long hours won't be worth it for you.

Many of us medical students have times when we could care less about what we're learning but what keeps us going is the promise of working with patients and having an affect on their lives in the future. So you see how you won't last too long in medicine if you don't have that basic motivation to help people.

 

[Compass]

Doctors, especially those in critical care areas like NICU, ICU, Trauma, etc., have to deal with a much lower patient survival rate than family medicine, peds, etc. from what I've seen. I got a pretty cynical lecture from an ICU doc when I shadowed.

 

[WorldChanger36]

It is about understanding limits. Physicians are limited to the knowledge they have about things. It is not that Docs don't care, it is that they are confidant they have done every thing they can for the patient. They can't sit around and feel bad about the guy all day or other patients my not get quality care. Being a good doctor is about knowing limits, when to push harder and when to fold. One day we may know how to heal a person with such problems but today we don't. So doctors do all that they can and move on. There was a time when AIDS was a death sentence and the best the doctor could do was help make the person comfortable, now people live decent lives with AIDS. Knowledge is a blessing and a curse, it advances us but it also limits us. People die every day and no doctor can save all of them, so take from this experence that when you are in the shoes of the physician that you will do all that you can for your patients, no more and hopefully no less.

 

[Snarkalark]

i think it also has to do with the environment of the hospital. the icu is like a sick person kennel, but i'm sure pcp's who know their patients for years and years care about them on a much more personal level.

 

[NickNaylor]

If a physician isn't interested in the outcome of his patient, I think that's a problem. That said, I don't think it's wrong - in fact, I think it's good - for a physician to be somewhat distant from his patient. Getting too emotionally involved with a patient would be bad for the health of both the patient and the physician.

 

[jeffro1080]

I think if you're a doctor and you grieved over every patient and cared to the point where you took it home with you, you'd probably go "nuts" not to long after becoming a doctor. I think the behavior that you described would be unacceptable in front of patients and family/friends, but it really isn't something to be ashamed of as long as you don't develop a "If he dies, he dies." attitude. That might be a sign of psychological pathology in and of itself. You need to find a healthy balance right in the middle.

[YOUTUBE]http://www.youtube.com/watch?v=BDgcc5Sif3k[/YOUTUBE]

 

[deleted307836]

If a physician isn't interested in the outcome of his patient, I think that's a problem. That said, I don't think it's wrong - in fact, I think it's good - for a physician to be somewhat distant from his patient. Getting too emotionally involved with a patient would be bad for the health of both the patient and the physician.

I completely agree with this. There is a big difference between fighting for the best possible outcome and personal emotional investment. You can, and should always be highly concerned about *outcomes*, but this does not require a significant emotional investment in the patient.

 

[LizzyM]

How much does the depersonalization of the ICU contribute to this attitude and behavior? If the data including results of procedures, imaging and lab results are the focus and the outcome is always the same, the bed is emptied (with a transfer to another unit or the morgue) and refilled with another patient who is circling the drain. It is not so much that death is inevitable as that death is unpredictable... maybe there is a 30% chance the patient is going to leave alive. You might "win" this one but more likely than not you won't but 30% is still high enough that you have to try without becoming emotionally involved.

 

[StudyShy]

It's known as compassion fatigue and results in a healthcare worker or even a family member taking care of a sickly person for a long period of time becoming more cynical, less empathetic, and more withdrawn when taking care of patients. Essentially, it comes from being "burned out" taking care of patients who are extremely ill and emotionally draining. Combined with the time restraints that physicians have for each patient, this can lead to feelings of frustration, loneliness, and an uncaring affect.

However, in the OP's case it sounds like maybe he/she is asking whether physicians really don't care about patients or whether it is normal for him/her to not care about patients on an emotional level.

 

[StudyShy]

How much does the depersonalization of the ICU contribute to this attitude and behavior?

I couldn't agree more. Patients aren't really treated like people at all in the acute care setting. It is easier when a patient is gorked out of his mind and ventilated to ignore that he/she is a real person.

 

[desi0chick]

I don't think it's so much that they don't care, but more so that they've already dealt with this alot so, basically they care but they don't express it emotionally?

 

[4ksibe]

one of the thing a physician explained to me is that it is easier to blame such patients for their condition and develop a somewhat aloof attitude towards them.... But even if you are goin to medicine cuz of the science, you still have that drive to see how your use of science would better a person's life which makes you somewhat care about the outcome dont you think?

 

[BigRedBeta]

As a future ICU physician (peds though, not adult), I can promise you that it's not that they don't care, but as others have said, it's a coping mechanism. This is all the adjustmore true in the adult ICU where mortality rates frequently approach 40%. And certainly when you have a patient who has obviously not taken care of themselves - which by and large, when you've gotten to hepatorenal syndrome, you've likely had a number of chances to make a change - it's all that much easier to not become invested. I'll readily admit my cynicism and tell you that one of the main reasons I went into pediatrics is because the patient rarely has done it to themselves. Even still, the deaths of chronic medical condition kids, the ones that are always in and out of the hospital tend to affect me far less than the kids who were otherwise healthy and caught a bad break.

Bottom line, what you've seen is not that uncommon, but more importantly there are places throughout the hospital where this sort of attitude is rare, where doctors do care deeply about each and every patient...it's just not in the ICU setting.

 

[circulus vitios]

one of the thing a physician explained to me is that it is easier to blame such patients for their condition and develop a somewhat aloof attitude towards them....

That's great because I already do that.

 

[WingedOx]

to be fair, after working call in the ICU, I kinda wished I was dead.