Saturday, July 11, 2009

Becoming the Fat Man.

Sleep-deprived and worried for my interns, I start spouting half-true or all-wrong or kind of right aphorisms as if I was aspiring to be the new Fat Man:

"All patients lie. All patients are crazy. And it is our job to love them anyway."

(Said to an intern who is tempted to believe everything his patients tell him, to his patients' potential detriment.)

A pair of nurses, overhearing this, do a double take and tighten up as they hear me start this, then visibly relax as I finish. One says, "You saved yourself with the last part there." I try to save myself a bit more: "Well, we all lie sometimes, even when we don't realize it, and we're all a little bit crazy, right?"

Still, I thought, Am I really the resident who blurts out cheap half-truths as if they were wisdom?

It is an inevitable temptation of power--even the minor power of a senior resident at the beginning of an intern's year--to start spouting bullshit. On reflection, I think I succumbed.

At the same time, I don't think it does any favors to patients to subscribe to a false humanism, some kind of big happy medical friendship bracelet of co-dependence between needy doctor and needy patient.

I got at what I was trying to say a little better a couple of days later, with the help of talking to Dr. Ms. Hemodynamics, who had more clear things to say about this problem, which I then said to an intern, with words something like this:

"It is inevitable that when we are feeling doubtful about ourselves as doctors, we want our patients to like us, because that makes us feel like we are good people. But it's not the point of being a doctor to have your patients like you. Your patients should come to trust you, and to respect your counsel, and value your role in their life. But liking you is beside the point, and it's dangerous to them for you to need that from them."

This I do believe.

To boil it down to a Fat Man-style law:

"It's not your job to have your patients like you. It's your job to love your patients enough not to care."

Friday, July 10, 2009

100% true dialogue from the wards

The attending, the senior resident, and the intern are sitting in the work area, discussing a patient. The senior resident, a bespectacled and bearded graduate of Harvard Medical School, is cautioning the intern on jumping to conclusions:

"I understand that you're taking the evidence and trying to see if it matches your theory. But actually, you want to do the opposite. You don't want to try to prove yourself right. In the philosophy of science, Karl Popper wrote about 'falsification'--the idea that you take your hypothesis and try to prove it wrong, until, failing to prove it wrong, you decide that it's the best theory for now."

The intern: "OK, yeah, I see your point."

The attending: "Karl Popper, huh? You've read Karl Popper?"

The resident: "No. But I've read about Karl Popper on Wikipedia."

Attending: Falls out laughing; retells the incident for laughs to another attending on rounds a couple of days later.

Resident: Laughs too; retells the incident on his blog a couple of days later.