Improving Education 291
Goals of positive outcomes of treatment need to be redefined. Physicians’ refusals to recognize fully that they, too, would one day face these issues in their own lives had psychological and adaptive advantages. This attitude allowed for denial of painful truths about death all around them, but could clearly cause problems, too.
Obstacles to Improving Care
Still, the more sensitive and enlightened practices and attitudes mentioned by these ill doctors were not always easy to follow. Empathy emerged as a daily challenge. Entering into the life of the patient, of‘‘ the Other,’’ and seeing that in medicine‘‘ a person waiting is a person suffering,’’ was hard. Even Roxanne, the gastroenterologist who, when on call, would ask a priest to bless her, occasionally found herself being rushed and preoccupied:‘‘ Sometimes I catch myself about to leave the room in a hurry, and ask,‘ Do you have any questions?’’’ Despite their best intentions, physicians could readily slip back into old patterns.
Roxanne tried now to think before speaking insensitively, but doing so was not always easy.‘‘ I try and stop a millisecond before blurting out something, but I’ m sure I’ ve blurted out stupid things. It requires a lot of self-control. You always have to be careful of your comments.’’
In incorporating lessons from their experiences as patients into their work as physicians, these ill doctors confronted troubling trade-offs. Spending more time with each patient forced them to see fewer patients overall. Jennifer said,‘‘ I probably became slow as molasses because I just wanted to make sure that every patient had everything taken care of for them.’’ Finally, unable to reconcile the conflict, she left clinical work entirely to devote herself to patient advocacy.
Some doctors did not feel instinctively communicative all of the time, and hence had to force themselves to enter the role of‘‘ the caring doctor.’’ Harry described doctors’ efforts to be empathetic as‘‘ playing’’ a part.
Part of what we do is play-act sincerity. We are there to be sincere, but some is playing our roles as confidante and dispenser of wisdom, security, and hope. I did not ever think of that as part of my persona.
Yet, patients may occasionally have unrealistic expectations or demands for time. Kurt said,‘‘ At times, I would spend tons of time with people; and with some, it just never was enough.’’