A Doctor's Perspective

[Fern]

As some of you know, i've been dating B., a neurologist, for about 3 months now. I'm always interested to hear a bit about some of his patients, a 51-year-old (his age, too) stroke victim, an elderly Parkinson's patient, and more than a few MS patients.

What i find very interesting is how cheerful a disposition B. can maintain, despite working very closely with people with serious chronic illnesses or sudden, unexpected things like a stroke. He has to talk to a lot of upset patients, plus their families.

I'm not sure i could do what he does without becoming seriously depressed. Somewhere along the way, he must have learned to distance himself from the emotional aspects of it.

But i think its' rubbed off on him in another way.

i grew up in a very nutrition-conscious household and with family members who are still like that today. One of my biggest interests, in addition to personal finance, is healthcare and nutrition and i enjoy keeping up on the latest clinical research. (Plus i have my own chronic condition, so i have good reason to.)

So i'm very diet and exercise conscious. Always been that way. Now, for the first time, i've met a man who matches me in that. I've been with people who say they are health-conscious, and then at dinner it's fries and a beer with their steak. But B. really IS very good with his diet. He always eats healthy and he's very conscientious about exercise, too. I'm quite impressed.

I think that's the way his occupation has rubbed off on him. Exposing yourself daily to lots of sickness and mortality i guess can have some good effects.

To our resident doc here, any thoughts on this topic, SteveDisney? Do they teach you anything in med school about dealing with the emotional aspects of one's patients or does it just sort of happen out of necessity?

[MonkeyMama]

I'm no doctor, but man, I think you have the personality and coping skills. A have great respect for anyone in such an "emotional" field. I have a friend who is a social worker as well - I wouldn't last a day...

[crabbypatty]

Well, I'll jump in.

I have a friend who was a substance abuse counselor when we met and was surprised at the lack of mental health training involved in her subsequent medical degree coursework. Hopefully residency would have provided it to someone without her background. But that all depends on your attending, right?

[creditcardfree]

I think those in the financial field also have to have some emotional coping skills. Money is a very emotional topic for many people. I worked in customer service for a mutual fund company and found people can get pretty emotionally charged regarding their accounts...especially in a bear market!

[disneysteve]

Here I am. Let me preface my comments by saying that I'm generalizing so what I say won't apply to everyone.

I tend to think that it isn't that doctors learn to be compassionate by taking certain classes in med school, but rather that it is certain personality types that are drawn to become doctors. So they already have that compassion going into it. Also, the more compassionate ones tend to gravitate toward specialties that demand that compassion more than other specialties that don't. Does that make sense?

Personally, I decided to be a doctor in 4th grade when I took my first Red Cross First Aid class. I know it sounds corny, but I loved learning how to help people who were hurting. That isn't something the instructor taught me. It was already there inside and the class just brought it out.

To some extent, doctors do need to emotionally distance themselves a bit from certain situations. Otherwise, we'd be unable to think clearly and rationally. There have been more than a few times over the years when that was quite difficult. And there have been more than a few times when I sat and cried right along with my patients. Sometimes life really sucks and us doctors can't do a damn thing about it. But at the end of the day, we need to move on to the next patient and the one after that and the one after that. That's just the nature of the job.

By the way, I'm also very diet and nutrition conscious, though I'll admit I've been slacking off in the exercise department lately.

[rob62521]

I'm going to put in my two cents just because I've dealt with so many doctors in the past few years -- for myself, my mom, and my mil. I think DisneySteve is right -- it's the personality that makes people care, not the courses. One doctor who dealt with my husband and my mom was just plain snotty, while another doctor my husband and I see for allergies is one of the sweetest men around. I hope I'm not making too many generalizations, but I think it's the person and the way they look at life. Remember the old film with William Hurt, "The Doctor". He treated his patients rather coldly and then he got ill. It changed his demeanor. I really wanted to purchase that movie for the guy who was less than nice, but he probably wouldn't appreciate it.

[kv968]

I'm going to put in my two cents just because I've dealt with so many doctors in the past few years -- for myself, my mom, and my mil. I think DisneySteve is right -- it's the personality that makes people care, not the courses. One doctor who dealt with my husband and my mom was just plain snotty, while another doctor my husband and I see for allergies is one of the sweetest men around. I hope I'm not making too many generalizations, but I think it's the person and the way they look at life. Remember the old film with William Hurt, "The Doctor". He treated his patients rather coldly and then he got ill. It changed his demeanor. I really wanted to purchase that movie for the guy who was less than nice, but he probably wouldn't appreciate it.

This brings up a "course" question I have. Are there any "speaking" or "communication" classes required in the curriculum of med school? The reason I ask is because my ex-brother-in-law is a doctor and he went from having nearly zero communication skills when he started school to being quite friendly and even somewhat out-going by the time he was finished with his internships. I always meant to ask him what brought about the change but never did. I'm not sure if it was any classes he took, real-life experiences dealing with people or a combination. I'm sure the real-life experience part played a huge role in it but was just wondering if there's any additional courses that are required. If there are, I know of a couple of doctors that must have flunked those courses

[disneysteve]

This brings up a "course" question I have. Are there any "speaking" or "communication" classes required in the curriculum of med school?

Not exactly, but many schools do role-playing as part of training, one student plays the patient, one plays the doctor and you get critiqued on your performance. Some schools, like mine, have paid professional "patients' who came in and each student got to play doctor for them. The "patient" actually did the evaluation in those cases. And the real life experience is huge. After a while, you learn what works and what doesn't, what comforts patients and what makes them more anxious, when it is okay to joke around and when you need to be serious. I don't think many people leave med school the same person they were when they walked in.

[genmed]

Not exactly, but many schools do role-playing as part of training, one student plays the patient, one plays the doctor and you get critiqued on your performance. Some schools, like mine, have paid professional "patients' who came in and each student got to play doctor for them. The "patient" actually did the evaluation in those cases. And the real life experience is huge. After a while, you learn what works and what doesn't, what comforts patients and what makes them more anxious, when it is okay to joke around and when you need to be serious. I don't think many people leave med school the same person they were when they walked in.

I am enrolled in medicine courses now (not medical school), and we've had a course on history taking and psychology courses. In each my experience has been similar where the students "interview" each other and get feedback. I'm also in a course this semester where we take histories from patients every week. Some of what you learn is out of necessity to get what information you need, as someone isn't going to respond to you if you don't learn to communicate well and some of it is just a great respect you develop for these people who are undergoing extraordinary things and many come out with a great sense of humor, a great outlook or a great amount of courage. It's hard for some of that to not rub off on you, IMHO.

[kv968]

I don't think many people leave med school the same person they were when they walked in.

Well I know at least for him that can be said. He went in a brainiac who could split an atom but couldn't make a PB&J sandwich if his life depended on it and came out...well let's just say he came out more "well-rounded"

[gackle]

Fern's initial posting about nutrition and the medical practice reminded me of my parents. They are both very health conscious now as well and have been researching nutrion and selling nutritional supplements. They say that a lot of doctors they run into have not been trained in nutrition, instead relying on training in medicine and pharmaceuticals. disneysteve, would you agree with this assertion?

[vsjhoc]

Not exactly, but many schools do role-playing as part of training, one student plays the patient, one plays the doctor and you get critiqued on your performance. Some schools, like mine, have paid professional "patients' who came in and each student got to play doctor for them.

How do you get a gig as a paid patient? Is this a part-time source of income for any of us, or do you need medical training? My brother is a doc, and he went to an OB-GYN conference where they had to practice exam techinques on patients. OK, there ARE some things I won't do for money ...

[disneysteve]

They say that a lot of doctors they run into have not been trained in nutrition, instead relying on training in medicine and pharmaceuticals. disneysteve, would you agree with this assertion?

Yes, I'd agree. I think doctors are just like everyone else and eat the typical American diet of deep fried crap with extra salt and an large side order of high fructose corn syrup.

At least when I was in med school, there wasn't a whole lot of focus on nutrition education. Hopefully, that's changed (I graduated in 1990). Certainly, we hear a lot more in the general media today about obesity, high fructose corn syrup, trans fats, organic food, whole grains, etc. I'm not sure how much of it sinks in but at least it is being spoken about.

The obesity epidemic is insane. Being on the front lines of it, I often feel like my hands are tied as far as having anything useful to offer my patients. Just this week, I saw a new patient who came to see me because of knee pain. She was 5'2" and weighed just under 300 lbs. And I see folks like that all the time with knee pain, back pain, breathing problems, sleeping problems, high blood pressure, diabetes, high cholesterol, etc. I don't know what they expect me to do for them when they are basically eating themselves to death. The really scary ones are the kids. I have numerous children in my practice who are at least 100 pounds overweight. These kids don't have any chance of living a normal lifespan at that rate.

I do spend a lot of time counseling patients about diet, nutrition and exercise. And I give out a lot of reading material. Unfortunately, very few patients actually take any of that advice. They'd rather keep eating junk and just take a pill to treat their conditions.

[disneysteve]

How do you get a gig as a paid patient?

I have no idea. I guess if there is a med school in your area, call them and ask if they are in need of anyone.

And yes, we had a paid "patient" who we practiced GYN exams on. Doris was her name and she had been doing it for years.

[Fern]

My original post had to do with my wondering how physicians like B. can remain cheerful, upbeat and happy without becoming depressed due to the many sick people he deals with.

Somehow the commentary veered off in the direction of how compassionate some doctors are, or aren't, or how well they communicate. To me these are different topics (tho still interesting).