“Will you be my doctor? The other doctor didn’t look me in the eye, kept checking his watch, and told me that I needed surgery. He didn’t answer my questions and never called me back. We just did not connect.”
I hear this occasionally (and I am certain that my former patients’ new doctors hear it, as well). Getting the elements of communication “right” between patient and physician is tricky, especially in the context of cancer surgery. The issues are not new.
|Over Labor Day weekend, I immersed myself in several of the stories in the collection, Chekhov’s Doctors (Jack Coulehan, ed. The Kent State University Press, 2003). Anton Chekhov, the noted writer and playwright, was a practicing physician; doctors figure prominently in many of his wonderfully crafted, timeless, and very readable stories. He brings to life physicians who display mixtures of compassion, cruelty, tenderness, greed, sensitivity, saintliness, arrogance, depression, despair, immorality, and existential conflict — in short, his doctors are flawed. Doesn’t that sound familiar!
In a story entitled “Ionitch,”
Chekhov’s physician protagonist begins as a poor energetic doctor who is welcomed to town by an artistic family; he soon falls in love with the beautiful daughter. Early in the story, she rebuffs his marriage proposal. He recovers, but the seeds of isolation and irritability have been planted.
Over the years, Ionitch focuses on working hard and making money. He becomes increasingly haughty, refusing all gestures of friendship. He grows rich.
By the end of the story, despite being a respected consultant, he is also corpulent and ill-tempered; when seeing patients, he raps his walking stick on the floor and shouts, “Be so good as to confine yourself to answering my questions! Don’t talk so much!”
Chekhov’s doctor has become a success, but his quest for wealth has left him detached and bitter. Chekhov focuses more on the relationships between the doctor and others than on the medical care rendered and he cleverly leaves most interpretation to the reader.
Transformations from eager neophyte to bitter dinosaur still happen today, believe it or not. Can doctors be taught to be compassionate? Or at least MIMIC it? How do we pass these cautionary tales on to our next generation of physicians?
How do we get students to absorb the lessons they will need to avoid becoming The Someone they never intended to be?
Instructive examples are abundant in classic and modern literature. However, during medical school and residency, there are persistent demands from hard sciences and overwhelming clinical duties. When I examine our medical school library's collection of medical fiction, poetry, and reflective essays, I notice that some of the volumes haven’t been checked out for months or even years.
Medical schools, including ours (I am proud to say), are developing Medical Humanities programs to find other ways to expose students to this “softer” aspect of Medicine. It is critical that we find ways for physician-writers like Williams
, Chekhov, Maugham
, and Coles
to teach students the following lesson: We, as doctors, are in danger of becoming complacent and arrogant when too many patients, parents, friends and acquaintances tell us that we are something special.
Because it just ain’t so.
That lesson won’t be on the final exam this year in medical school, but it might be important much, much later to our patients, our families, and ourselves.
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