Terminal Illnesses

[Sparda29]

I've been shadowing with 2 physicians(one general surgeon, one pulmonary medicine - this guy sees a lot of lung cancer) for about a month now. I don't think that I have the capability of telling someone that they are going to die or their family member is going to die. Is this something necessary in the field of medicine or can a physician who cannot do this just ask a colleague to do it for them?

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[SarsMO]

This is necessary in medicine. You'll even have classes in medical school on how to deliver bad news where you practice with standardized patients. Sorry, but you're going to have to deliver bad news, and depending on the specialty, you might experience it often.

 

[Sparda29]

I guess so. I mean the doctor I was working with, had already told the patient that they were going to die and was just so damn good at comforting them about it, and the patient and the doctor were joking with each other about it and about different means of euthanasia.

 

[StevenJ128]

After a while in the hospital, you'll learn to disassociate.

 

[EpiPEN]

After a while in the hospital, you'll learn to disassociate.

that makes me die a little on the inside

 

[StevenJ128]

that makes me die a little on the inside

Don't worry, that'll pass too.

 

[EpiPEN]

Don't worry, that'll pass too.

no that's just the gas, the thing that dies just stays there, unmoving while I bury it in cynacism and sarcasm

 

[DocRunner07]

Don't worry, that'll pass too.

Um...you do realize you are a pre-med right? How many people have you told they are going to die? I may be wrong but I doubt you have that much experience in a hospital either to even know what it is to "dissociate". Just becuase you have seen every episode of scrubs does not mean you understand a thing about real situations in hospitals or that you could even handle them...I mean how would you even know? But here you are handing out advice like you have experienced it...

 

[8744]

The cool thing is when you have "the talk" with the family and, if you preface your remarks with something like, "As you know, you mother is very sick and has many medical problems," and they look at you like you are a Martian.

"Whaddya' mean," the family will say, "She was all right before she came to the hospital," and they seem genuinely shocked that coronary artery disease, lymphoma, emphysema, diabetes, chronic renal failure, hypertension, strokes, dementia, and the usual co-morbidities accumulated by many of our elderly patients are serious medical problems.

It's like asking people if they have ever had any medical problems and, despite seeing pacemaker spikes on the monitor and a big bypass scar on their chests they say, "No." Or idly dropping in a conversation that Grandma who has five stents, a defibrillator, and a four-vessel bypass has heart problems and having the family act shocked and insulted that you could suggest such a thing.

 

[Wylde]

I've been shadowing with 2 physicians(one general surgeon, one pulmonary medicine - this guy sees a lot of lung cancer) for about a month now. I don't think that I have the capability of telling someone that they are going to die or their family member is going to die. Is this something necessary in the field of medicine or can a physician who cannot do this just ask a colleague to do it for them?

I think most physicians will require you to tell the family, especially during residency.

The only way to avoid it would be to go into specialties where you won't be involved in this (ie Radiology, pathology, psychiatry, opthalmology, PMR, etc.)

 

[phoenix0610]

Take an elective or volunteer at a hospice--the doctors that work there are amazing at handling very difficult situations with dignity and grace, and you'll learn how to cope with it yourself. Turn your analysis inward and try to figure out why you are so uncomfortable with death and dying--the answer may suprise you...

 

[Law2Doc]

... or can a physician who cannot do this just ask a colleague to do it for them?

You have to be joking. Do you seriously think that a doctor can turn to another and say, "Hey Bob, do me a solid and go tell this family that Auntie Em just died. Thanks bud." You don't get to pass the buck in medicine. This is something you learn to overcome. It isn't the high point in anyone's day, but everyone goes through this situation at least once. In some specialties it's more like once a day. And as Panda suggested, the family tends not to always handle the news rationally or help you along. It's kind of why medicine is not for everyone and why the adcoms are so keen on finding out how "mature" all applicants are. Medicine is serious business. The hospital isn't just your personal playground to learn in. It's a place where people are sick and die.

 

[Sparda29]

The thing is that the doctor I was working with let me practice that with him. I couldn't keep a straight face.

When I was in the exam room with him in the patient, I couldn't look the patient in the eye when he was delivering the news.

 

[kevinm]

After a while in the hospital, you'll learn to disassociate.

I don't mean to target you directly, but rather the statement you made. That line of thinking makes me cringe; as a doctor, one can never allow his or her emotions to cause duress to the point of incapacitation. That does not mean dissociation. Ever.

I'm not a doctor, and I'm barely a pre-med. I mean I've taken the courses, but here's the deal, I barely got through them. That's not because of a lack of interest or a lack of intelligence -- I'll be graduating with two engineering degrees (two diplomas) in May, a minor in French, and over 200 credits. I'm a paramedic and work my ass off on the side. And I volunteer as an EMT in a local agency. I mentioned all of this because this job is not about prestige, it's not about being the best at math or organic chemistry (which I failed, by the way). It's about a passion for helping people, a skill at it. You have to be able to treat patients with respect and you have to be able to comfort them with your words. I've dealt with a lot of doctors in my line of work, and the ones whom I find to be awful are the ones who completely dissociate themselves from their patients. But I'm sure they had a 4.0 and >40 MCAT. If you really want to be a good doctor and if you really want to excel in the medical field, you can't turn off your feelings or your emotion. You need to put your all into every patient.

About the medical profession, yes, people die. And as a doctor, delivering that news to a terminal patient or to his or her family is a daily reminder that you ARE human. While I'm sure there are courses that attempt to 'teach' the explanation process, I fervidly believe that it's something that comes from within.

Sorry about the rant, I'm just really sick of people watching TV shows like House or Scrubs or ER and thinking that you have to be a frigid bastard to be a good doctor. Nothing could be further from the truth.

 

[8744]

I don't mean to target you directly, but rather the statement you made. That line of thinking makes me cringe; as a doctor, one can never allow his or her emotions to cause duress to the point of incapacitation. That does not mean dissociation. Ever.

I'm not a doctor, and I'm barely a pre-med. I mean I've taken the courses, but here's the deal, I barely got through them. That's not because of a lack of interest or a lack of intelligence -- I'll be graduating with two engineering degrees (two diplomas) in May, a minor in French, and over 200 credits. I'm a paramedic and work my ass off on the side. And I volunteer as an EMT in a local agency. I mentioned all of this because this job is not about prestige, it's not about being the best at math or organic chemistry (which I failed, by the way). It's about a passion for helping people, a skill at it. You have to be able to treat patients with respect and you have to be able to comfort them with your words. I've dealt with a lot of doctors in my line of work, and the ones whom I find to be awful are the ones who completely dissociate themselves from their patients. But I'm sure they had a 4.0 and >40 MCAT. If you really want to be a good doctor and if you really want to excel in the medical field, you can't turn off your feelings or your emotion. You need to put your all into every patient.

About the medical profession, yes, people die. And as a doctor, delivering that news to a terminal patient or to his or her family is a daily reminder that you ARE human. While I'm sure there are courses that attempt to 'teach' the explanation process, I fervidly believe that it's something that comes from within.

Sorry about the rant, I'm just really sick of people watching TV shows like House or Scrubs or ER and thinking that you have to be a frigid bastard to be a good doctor. Nothing could be further from the truth.

The real truth is that while I feel sorry for the families and patients and am no more or less compa**ionate than anyone else in this world, it's not my family member who is dying so except that every death reminds us the tenuous connection we all have to life, it's not as if I am really involved except as a sort of middleman. I didn't kill the patient, after all so my lack of whatever it is we're supposed to feel is not dissociation at all but a decent regard for the feelings of people who may really be grieving. Generally, it is enough to deliver the bad news, answer any questions, and leave the families to themselves.

Nobody likes a crying, weepy doctor by the way. It spooks the patients.

 

[ACSurgeon]

You have to be joking. Do you seriously think that a doctor can turn to another and say, "Hey Bob, do me a solid and go tell this family that Auntie Em just died. Thanks bud." You don't get to pass the buck in medicine. This is something you learn to overcome. It isn't the high point in anyone's day, but everyone goes through this situation at least once. In some specialties it's more like once a day. And as Panda suggested, the family tends not to always handle the news rationally or help you along. It's kind of why medicine is not for everyone and why the adcoms are so keen on finding out how "mature" all applicants are. Medicine is serious business. The hospital isn't just your personal playground to learn in. It's a place where people are sick and die.

For some reason, this made me laugh really hard...

 

[lord_jeebus]

Having done this talk several times in the past week, I can say that

-it's not that hard
-it gets easier every time
-I actually feel a sense of accomplishment when I get it to go well - obviously they need the news and there is some satisfaction from communicating things well and being the kind of doctor who handles these things in a caring and informative way

 

[kevinm]

The real truth is that while I feel sorry for the families and patients and am no more or less compa**ionate than anyone else in this world, it's not my family member who is dying so except that every death reminds us the tenuous connection we all have to life, it's not as if I am really involved except as a sort of middleman. I didn't kill the patient, after all so my lack of whatever it is we're supposed to feel is not dissociation at all but a decent regard for the feelings of people who may really be grieving. Generally, it is enough to deliver the bad news, answer any questions, and leave the families to themselves.

Nobody likes a crying, weepy doctor by the way. It spooks the patients.

Of course no one likes a crying, weepy doctor. What I meant was that it's generally in poor taste to lack compassion and to deliver the news in a cold manner... while it's not your family member who's dead or dying, it very well could be, and for that reason, being caring and compassionate is expected.

 

[pianola]

For some reason, this made me laugh really hard...

Me too! I had to close the door so I wouldn't wake up my family. .

I have NEVER heard anyone use the expression "do me a solid" but I sure as hell plan on using it in a secondary .

 

[calnation]

I like to walk into hospitals with a white coat on and get some practice. It's quite simple actually. Just ask someone the last name of the patient they're waiting for and you can take it anywhere from there.

Just remember to run really fast when you get caught!

 

[MightyDucksMan]

I think this whole thread is a good example of the weaknesses of the obsession with academia that is pushed on pre-meds right now. I know so many people who are outstanding researchers because that is what we are told to do to build resumes, but their experience with sick and dying people is completely lacking. I work with a lot of terminal patients and a couple nights ago talked for a couple hours with a guy in his late 40s who was refusing treatment for leukemia because he didn't want to suffer anymore. Unfortunately for him, he hadn't arranged hospice yet so he was being put through several discomforting tests/day to try and determine why he was having abdominal problems. I really couldn't tell if it struck the doctors just how horribly they were treating this guy.

I'm rambling, but my point is if you are struggling with death, like someone already said, go volunteer at a hospice facility or get a job working with patient support staff at a hospital or nursing home. You'll learn how to put yourself in the place of a patient and their family when you spend 12 hours taking care of them, and you can actually be genuine when you tell them you understand.

 

[AmoryBlaine]

The cool thing is when you have "the talk" with the family and, if you preface your remarks with something like, "As you know, you mother is very sick and has many medical problems," and they look at you like you are a Martian.

"Whaddya' mean," the family will say, "She was all right before she came to the hospital," and they seem genuinely shocked that coronary artery disease, lymphoma, emphysema, diabetes, chronic renal failure, hypertension, strokes, dementia, and the usual co-morbidities accumulated by many of our elderly patients are serious medical problems.

It's like asking people if they have ever had any medical problems and, despite seeing pacemaker spikes on the monitor and a big bypass scar on their chests they say, "No." Or idly dropping in a conversation that Grandma who has five stents, a defibrillator, and a four-vessel bypass has heart problems and having the family act shocked and insulted that you could suggest such a thing.

See you that and raise you one. I had a daughter of an elderly patient become irate with me for suggesting that her nonegenerian father in the NeuroICU had had an ischemic stropke and a heart attack. Despite my having a CT that an M1 could have read and a trop value about 5x upper limit she insisted that I was somehow trying to malign her dad.


Side note, which we've all experieinced:

"Do you have any medical problems?"
"No."
"Do you take any medications?"
"Let's see, Lipitor, Lisinopril, HCTZ, Metoprolol, Synthroid, Gemfibrozil, Gabapentin, Paxil, Ambien, Vicodin, and one or two others maybe."

 

[MSHell]

Side note, which we've all experieinced:

"Do you have any medical problems?"
"No."
"Do you take any medications?"
"Let's see, Lipitor, Lisinopril, HCTZ, Metoprolol, Synthroid, Gemfibrozil, Gabapentin, Paxil, Ambien, Vicodin, and one or two others maybe."

From a guy admitted for the 3rd time for acute pancreatitis:

"Do you have any medical problems?"
"No."
"Are you diabetic?"
"No."
"Do you have high blood pressure?"
"Well, a little..."
"Do you have....(ad nauseum)?"
"No."
"Do you take any medications?"
"No."
"Do you take insulin?"
"Yes." (goes on to tell my the types and dosages and ...)

 

[EpiPEN]

From a guy admitted for the 3rd time for acute pancreatitis:

"Do you have any medical problems?"
"No."
"Are you diabetic?"
"No."
"Do you have high blood pressure?"
"Well, a little..."
"Do you have....(ad nauseum)?"
"No."
"Do you take any medications?"
"No."
"Do you take insulin?"
"Yes." (goes on to tell my the types and dosages and ...)

why would you directly ask the guy if he was taking insulin if he said he wasn't diabetic? It just seems like a strange train of logic

 

[8744]

why would you directly ask the guy if he was taking insulin if he said he wasn't diabetic? It just seems like a strange train of logic

Some of the patients are strange...and people with chronic pancreatitis often (usually) have diabetes.

 

[EpiPEN]

Some of the patients are strange...and people with chronic pancreatitis often (usually) have diabetes.

that I get, but he had already asked the patient whether or not he was diabetic. So why would he then ask if he takes insulin? it's not like chronic pancreatitis patients need it...

 

[Droopy Snoopy]

Side note, which we've all experieinced:

"Do you have any medical problems?"
"No."
"Do you take any medications?"
"Let's see, Lipitor, Lisinopril, HCTZ, Metoprolol, Synthroid, Gemfibrozil, Gabapentin, Paxil, Ambien, Vicodin, and one or two others maybe."

If you're lucky... more often than not I get 'mood pill, blood pressure pill, sugar pill, etc.' and have to play 20 questions.

 

[Sparda29]

If you're lucky... more often than not I get 'mood pill, blood pressure pill, sugar pill, etc.' and have to play 20 questions.

I know what you mean. I work at a pharmacy. Whenever people call in for refills and stuff, it is hilarious and annoying to listen to them when they want to refill it.

I cannot believe that people are that uneducated about what they are putting in their systems. It's an epic phailure by physicians who prescribe without explaining how the drugs work and what they are targeting, and pharmacists who just fill the prescription without talking to the patients about it.

 

[tiedyeddog]

It seems like all pre-meds believe one central theme: YOU MUST HAVE PASSION IN MEDICINE OR YOU SUCK AT LIFE.

Just for the record, I doubt many patients care too much about how much compassion you have or passion for medicine you have in general. They want the problem fixed and for you to preform as well as the next guy in your specialty.

If you don't want to deal with terminal illness then go into a specialty that has little of it. My dad was an orthopod and he often told me mortality played a huge part in why he went into orthopedics; He liked how most of the patients became "better". Some specialties are more about regaining a life style rather than saving a life. People who could not emotionally tolerate giving a "death sentence" might head toward the latter former specialties.

I think there are more than a couple studies that have been done concerning how med students are taught to internalize patients as objects in order to keep them sane. I will give a cite when I find the book one of the studies is in.

 

[EpiPEN]

...
Just for the record, I doubt many patients care too much about how much compassion you have or passion for medicine you have in general...

Agreed with most, but I beg to differ on this point


I have a feeling a lot of people perfer a friendly compassionate face as their doc.

 

[tiedyeddog]

Agreed with most, but I beg to differ on this point


I have a feeling a lot of people perfer a friendly compassionate face as their doc.

Since my statement really depends on the person, I'll say you're right. However, let me give you this hypothetical situation: There are two neurosurgeons within 300 miles of the area you live in. You have a aneurysm that might blow at any minute. Do you see the compassionate nice surgeon with a bad surgical reputation or the surgeon who is mean as hell but has a better track record?

Here are those cites on the conditioning of medical students and one on how workers at a animal shelter deals with killing perfectly healthy animals at a crowded animal shelter.

1. "Managing Emotions in Medical School." Allen C. Smith III and Sherryl Kleinmann
2. "Managing Emotions in an Animal Shelter." Arnold Arluke
Both are found in "Inside social life" By Cahill. Both contain references to many other studies backing up the presented data.

 

[EpiPEN]

...Since my statement really depends on the person, I'll say you're right. However, let me give you this hypothetical situation: There are two neurosurgeons within 300 miles of the area you live in. You have a aneurysm that might blow at any minute. Do you see the compassionate nice surgeon with a bad surgical reputation or the surgeon who is mean as hell but has a better track record?...

Yeah but not only does it depend on the person, but it also depends on the specialty. Neurosurgery, family practice, dermatologist, general surgeon, cardiologist, etc. will vary on the degree that people might care about the doctor's attitudes.

Imagine this hypothetical situation. Two oncologists. One doctor has compassion and cares deeply fo rhis patient's wellbeing while the other doctor is an insensitive jerk who has a better record on paper. If you had mid to late stage cancer who would you want by your side through the diffcult and long road that lies ahead of you?

Personally, I'm a hard fact statistics number person. However, I recognize that there will be plenty of people (and I might even say most people but that will be pure speculation) out there who would choose very differently than me.

 

[Law2Doc]

that I get, but he had already asked the patient whether or not he was diabetic. So why would he then ask if he takes insulin? it's not like chronic pancreatitis patients need it...

Your goal is to get accurate information, not just go through your list of questions. Many many times during the discussion you ought to rephrase things to see if when asked a different way, you glean different info. There's no worse feeling as a med student than presenting to your attending who then goes in to talk to the patient and gets the exact opposite story.

Asking about specific meds that some patients don't think of as meds (insulin, OTC stuff, herbs) is often a good idea. Also when you ask your patient if he uses any "street" drugs, it pays to go through a laundry list because you'd be surprised about the number of patients who don't use any drugs but do use marijuana and blow. Also when you ask about venereal disease, you have to list them out because many patients don't realize that the HIV, syphilis, gonorrhea and herpes they contracted are venereal diseases.

 

[pianola]

There's no worse feeling as a med student than presenting to your attending who then goes in to talk to the patient and gets the exact opposite story.

I see this all the time shadowing a physician in academic medicine. The patients are entirely unclear with the med student/resident and then when the physician comes in, all of a sudden the story changes and it's as if the patient all of a sudden remembered he was a different person.

So irritating.

 

[tiedyeddog]

Personally, I'm a hard fact statistics number person. However, I recognize that there will be plenty of people (and I might even say most people but that will be pure speculation) out there who would choose very differently than me.

I agree with your point. I am a numbers person, too, but I can see how someone would choose based on other methods.

 

[MSHell]

Some of the patients are strange...and people with chronic pancreatitis often (usually) have diabetes.

Exactly my line of thinking. Maybe his pancreatitis wasn't his only pancreatic problem. Who knows what else he was hiding?!

And the point is to get as much info as possible. Many don't realize that insulin, vitamins, etc should be mentionned. Many don't like mentionning anti-depressants or street drugs.

And some patients are just plain weird.

 

[spyderracing32]

Of course no one likes a crying, weepy doctor. What I meant was that it's generally in poor taste to lack compassion and to deliver the news in a cold manner... while it's not your family member who's dead or dying, it very well could be, and for that reason, being caring and compassionate is expected.

Well no one here is claiming that the best way to deliver the news is to walk in, say "He/She is dead.", rattle off the cause(s), and walk right out the door. You're not talking to a bunch of pre-med robots sent from the future to destroy the curves in their under-grad orgo classes; we are people too.

 

[kevinm]

Well no one here is claiming that the best way to deliver the news is to walk in, say "He/She is dead.", rattle off the cause(s), and walk right out the door. You're not talking to a bunch of pre-med robots sent from the future to destroy the curves in their under-grad orgo classes; we are people too.

I tend to forget that there are some pre-meds amongst us who are human. At my school, the pre-meds are so far removed that they probably couldn't even tell you who the current president is. But ask them about friedel-crafts acylation and...oh nevermind. you get the idea.

 

[8744]

...It seems like all pre-meds believe one central theme: YOU MUST HAVE PASSION IN MEDICINE OR YOU SUCK AT LIFE...

I have very little pa**ion for This Mother****er but I do mostly enjoy my job. Pa**ion is just not necessary. You get up, go to work, come home. Some of the patients are interesting, most are not, most are decent people, and the rest contribute to the "freak-show" atmosphere of modern American medicine. You actually touch very few lives and when the patients are processed through the sausage mill that we call "The Hospital" you are just another face who asked them a bunch of questions.

Most pre-meds are pa**ionate about the idea of medicine which is not the same as being pa**ionate about medicine itself, a profession that can be something of a grind.

In fact, it's best to be dispassionate.

 

[Droopy Snoopy]

.

 

[AmoryBlaine]

I have very little pa**ion for This Mother****er but I do mostly enjoy my job. Pa**ion is just not necessary. You get up, go to work, come home. Some of the patients are interesting, most are not, most are decent people, and the rest contribute to the "freak-show" atmosphere of modern American medicine. You actually touch very few lives and when the patients are processed through the sausage mill that we call "The Hospital" you are just another face who asked them a bunch of questions.

Most pre-meds are pa**ionate about the idea of medicine which is not the same as being pa**ionate about medicine itself, a profession that can be something of a grind.

In fact, it's best to be dispassionate.

Yeah, I don't think you have to have a passion for it be sucessful. Do I enjoy medicine? Yes. Is it my "passion?" Well, no.

I mean if all I did was rescusitate sick people, set broken bones, repair nasty lacerations, save lives I might be passionate about it. But it's pretty damn hard to be passionate about charting and medication reconciliation.

 

[tiedyeddog]

Most pre-meds are pa**ionate about the idea of medicine which is not the same as being pa**ionate about medicine itself, a profession that can be something of a grind.

In fact, it's best to be dispassionate.

I would imagine that being "compassionate" every minute you are working would be too mentally taxing. I'm going to guess there are select times when compassion and outright emotional display is appropriate but many times it might hinder your ability to do your job. I don't know but it's just a guess.

 

[DrJosephKim]

This is one of the most difficult things to do. Make sure you don't distance yourself too much. Studies have shown that medical students grow more cynical and emotionally 'numb' as they advance in their training. Although that's a sad reality, make sure you stay mentally healthy and get appropriate support when you need it.

 

[inhiding]

Yeah, I don't think you have to have a passion for it be sucessful. Do I enjoy medicine? Yes. Is it my "passion?" Well, no.

I mean if all I did was rescusitate sick people, set broken bones, repair nasty lacerations, save lives I might be passionate about it. But it's pretty damn hard to be passionate about charting and medication reconciliation.

And yet, most pre-meds are required to be extraordinarily passionate about charting vitals and paging the nurse. Or so their secondaries might suggest. .

 

[MightyDucksMan]

Panda - Just out of curiosity, which residency program are you in? You sound kinda like a gen surg lol...

 

[8744]

Panda - Just out of curiosity, which residency program are you in? You sound kinda like a gen surg lol...

Emergency Medicine. But I have done six months of ICU rotations in the last three years so not only do I see a lot of really sick people in the Emergency Department but the ultimate in sick and co-morbid in the ICU.

I think some of you have no idea how sick people can be and yet not only cling to life but have hundreds of thousands of dollars spent to keep them ticking even if they are completely demented, and breathing, eating, urinating, defecating, and otherwise completely living through tubes.

I had one such patient who was, additionally, crapping directly into a nasty sacral decubitus ulcer that had eaten so deeply that it had formed a fistula with the patient's rectum. Sure enough, the family wanted surgery to place a colostomy (diverting the bowel into a pouch on the abdomen) so their demented, stroked-out, totally immobile mother with the implanted defibrillator-pacemaker to keep her from dying quickly and a pathology textbook's worth of competing conditions could linger for another few months in a nursing home. You see, the patient was septic from the infected ulcer and, as stool is pure bacterial goodness, the only way to prolong her now completely pointless life would be debride the ulcer but this could only be done if she could stop crapping into it.

Insanity. In a merciful world this lady would have been allowed to die five years ago instead of lingering in a twilight death while we debate rerouting her bowels. The family was clueless and were shocked, genuinely shocked, when I suggested that their grandma' was really sick and that it was time to consider "comfort care," not the usual aggressive violence we had been inflicting on the poor woman. I mean, I intubated her, shocked her, jammed central lines into her and even placed a dialysis access catheter because of her acute (on chronic, of course) renal failure.

 

[tiedyeddog]

I had one such patient who was, additionally, crapping directly into a nasty sacral decubitus ulcer that had eaten so deeply that it had formed a fistula with the patient's rectum......

Panda, I agree with your stance but don't many religious denominations it is a sin to not keep "pushing"? Do you feel it is the justified to keep such hopeless cases going, if it is justified as "this is what my religion dictates we should do"?

 

[MightyDucksMan]

Panda - I guess it makes more sense now - gen surg never actually has to deal with the people long enough to realize how bad off they are (my brother's a 5th year resident, so I'm not completely talking out of my a**). I'm not sure if your hospitals use sitters, but my job is basically to physically restrain those demented, tube-living individuals while they frantically try to pull out PICC lines, catheters, etc. Why I still am applying to med school I'm not 100% sure, but I do think that seeing all these disasters doesn't mean you have to totally check out emotionally. I tell myself that the reason for me to get into medicine is so that I can help counsel patients and families about how insane some of these practices are. Of course we all know they won't listen, but I can be delusional can't I? My biggest concern is that too few students applying to med school have any concept of how idiotic keeping people alive at all costs is.

 

[Sparda29]

Agreed with most, but I beg to differ on this point


I have a feeling a lot of people perfer a friendly compassionate face as their doc.

Honestly, if I was really sick, I could care less how nice the guy was as long as he could get the job done and cure me.

 

[Climberak]

The hardest time for me was talking (or attempting to talk) to a guy who had wernickie's aphasia. He looked at me and asked if he was going to get better. I knew he wasn't going to, but I couldn't give him a straight answer. You feel awful the first few times you're in these kind of situations, but things get easier as you go. Clinical experience in settings such as an ER, ICU, outpatient care, hospice, etc. can really help to expose you to these kinds of situations.

Even if you choose a specialty like opthamology, where the chance of telling a patient they are going to die is slim, you will still have to tell them unfortunate news, i.e., they are going blind, or they will lose an eye. In our attempt to heal patients, we will win some and we will lose some. When we lose, it is our responsibility to inform those that we have cared for and their families.