Detachment

I was reading some interesting stories on another medical blog: www.ahyesmedschool.blogspot.com and I started thinking about detachment. One person wrote to the blogger "Do they teach you detachment in medical school?" to which I immediately thought "They should!". The blogger actually replied that no, in med school we learn to be sensitive, communicative, respectful, touchy-feely types. Which, of course, just makes it worse when we become real doctors and have to see more patients than we can handle, deal with death, dying and lawsuits, see outcomes and life events we would rather not and generally get slammed with all that goes with handling issues of life and death.

Some of us overload and drop out, some have breakdowns, some stress out and take it out on their partners and family. The rest of us learn detachment. I think detachment comes with realizing that it is not all your fault, that you can't make it all better, that you can't even make it as good as possible because little things like money get in the way. Detachment is learning to leave it at the hospital door when you leave. I suppose patients think detachment is a bad thing - I keep hearing how doctors don't empathize enough and aren't available enough to patients. I think the reality is that we have to have enough sense of self to have some patient-free time in our lives.

Some patients do follow you home. After running a resus (especially one that fails) it does stay in your mind. Knowing a mother is about to bring a lawsuit against you does pop into the head at odd moments, even if the case it totally unjustified and everyone tells you not to worry about it. Worrying is part of being a doctor.

I think it is the old balance problem. How to be sensitive and empathetic and sympathetic, and yet how to hold yourself far enough away that all their problems don't become your problems. I wonder if this is why there is such a culture of anger in medicine? (I sometimes think it is because of the male dominated nature of medicine as well.) It is acceptable to rant and rave and complain about the patient's family, about the hospital system and the government. It is acceptable to be angry with incompetent referrals from the ED, even to yell at the resident on the phone. It is somehow not acceptable for the doctor to cry, to admit to feeling guilty, or inadequate or even inexperienced in some circumstances.

Doctors are under pressure to be inhumanly perfect, inexhaustible and altruistic. When we fail these expectations we are branded flawed, faulty, greedy, selfish - usually to the tune of several million dollars. Ah yes, medical student, you will be walking a fine line, and the conversion from Fake Doctor to Real Doctor is by walking through the refining fire of responsibility. Don't wish for it too soon.