FEATURE
we forget we are caring for human beings with needs beyond their medications, surgeries, tests and their multitude of forms. Humanism often gets swept under the rug in favor of the never-ending push to“ move the meat.” I recently read an article written by Dr. Boris Veysman in the Annals of Emergency Medicine on the topic of“ moving the meat.” Dr. Veysman expressed his utter frustration regarding our health care system’ s value on efficiency over the integrity of medical care. He related that he saw“ moving the meat” in action first hand when an extremely busy emergency medicine resident missed acute glaucoma in his own grandmother. In the closing line of his article, he asserted that“ If you’ re movin’ meat, you may be a butcher. Real emergency physicians thoughtfully care for patients.” I agree with Dr. Veysman and think the push for efficiency and speed in our health care system has the potential to harm patients in many ways, from doctors missing a life- or limb-threatening diagnosis to subtler errors, omissions and emotional tolls on both patients and doctors.
One of the things I find most frustrating about modern medicine is the very unequal ratio of time spent doing administrative work / computer tasks / documentation to quality time at the bedside with patients. Speed and efficiency reign sovereign in our current system, and it has become very difficult for physicians to thoughtfully consider each patient’ s case, much less spend meaningful time at every patient’ s bedside— at least not without feeling rushed or distracted. After all, how could we possibly have time to do this when we are seeing 20 + patients per day as a primary care physician, caring for 30 + patients in a 12-hour emergency department shift, or rounding on 20 + patients per day on a hospital service? Caring for high volumes of patients in an age where documentation requirements and administrative tasks have exploded is not in the best interest of our patients or physicians. It places patients at a higher risk for becoming victim to medical errors or omissions, and markedly predisposes doctors to burnout. Moreover, if we become stuck on speed, we risk neglecting the human side of medicine, the part that prompted us to pursue this profession in the first place.
Recently I was reminded that sometimes we must put aside our sundry doctoring tasks( they will never go away) and focus on the fundamentals of medicine. I was working ICU night shifts last winter, working with an emergency medicine intern who earned my highest respect. One of our patients became extraordinarily ill, and despite the best efforts of multiple nurses and physicians, this patient died. Emergency medicine doctors are often stereotyped as the crazy yet stoic cowpokes of medicine, but this intern no doubt crushed that stereotype. It was his idea to stay behind after the patient’ s death, and together with the patient’ s nurse and myself, we bathed the patient and changed his blood-stained clothing before his family arrived to see him. We gave dignity to this patient, even in death, and that matters more than any documentation in the EHR or administrative task we will ever complete. We were doctors for this patient to the very end, and I will never forget that intern’ s sense of responsibility and loyalty to this patient even in death. He truly was placing humanism above all else. I loved being witness to that.
It bothers me that some people stereotype us as being“ holier than thou.” I know doctors are inherently good people with good intentions. Not long ago, I walked into the patient’ s room, where the stench of fresh stool hit me like a bag of bricks. This was a true“ code brown.” The nurse was struggling to move the patient without making a bigger mess, and so I helped them out in this tricky situation. The next day, I went back and heard that several nurses were talking about me; apparently, they were impressed that I had helped. When I asked why, they told me that most doctors would run the other way and never dream of helping out in such a situation. They told me to never change, as it was refreshing to see. Doctors, I want this stereotype to go away. If one of our health care colleagues needs help caring for a patient in any capacity( especially when there is no one else around to help), it is our responsibility to help for the sake of the patient, not to let hubris and / or our preoccupation with our mountain of duties get the best of us. These negative perceptions of doctors will persist until we all show that we are on the same team.
I can’ t begin to fathom what it will take to fix our broken health care system. It is vital for us to engage in health advocacy to enact positive change at national, state and local levels. Beyond that, there’ s so much we can do on an individual level to promote humanism in medicine, despite all the annoyances we must deal with in our jobs. We are not just cogs on the machine of our broken system, we are not workers on a factory line. Rather, we are healers, listeners, innovators, scientists, caretakers and team players who individually and collectively have so much to offer to humanity if we put our minds to it.
Doctors, take extra minutes to listen to your patient, and do it at eye level without your hand on the door knob. Hug someone who needs it. Bring your patient a pitcher of water. Sit in silence with a grieving family. If your patient with metastatic cancer is hankering for a piece of chocolate, go find her some. Bring your sick patient’ s husband a cup of hot coffee. Basically, be like my grandma and make your patients and colleagues feel valued and loved even when the system we work in feels hopelessly dysfunctional.
These are the things that differentiate the good doctors from the great doctors – be a great one. If you don’ t, Loretta Louise Pilson, my feisty German grandma who promised to haunt me if I misbehaved, will haunt you!
Reference Veysman, B. D. Butchers Move The Meat; Doctors Care for Patients.( 2010). Annals of Emergency Medicine, 56( 5), 578-579.
Suzanne McGee, MD, is the Chief Medical Resident for the UofL Internal Medicine Program.
22 LOUISVILLE MEDICINE