Saturday, November 21, 2009

Mask of Medicine

It's curious that I've been talking about my adventures in med school a lot recently (most of my posts since August), and yet I've failed to explicitly discuss the Mask of Medicine that practically all med students, residents, and doctors wear. Unlike my other Masks, this Mask has some physical manifestations as a white coat, scrubs, and/or stethoscope.

This is a Mask that trumps all other Masks. When it's worn, next to nothing else matters. Time melts away, personal dramas are set aside, and you push through drowsiness and exhaustion - all that matters is that person in front of you. To say, "How can I help you?" or "What brings you in today?" and have a total stranger tell you some of his most intimate details of his life, to place his trust in you, how can you even dare think about anything else but that person in that very moment? All you care about, all you should care about, is helping that person the best you can. And when you do your best and you know that, you feel a distinct sense of achievement.

I'll be the first to admit I'm not the best med student in the class, book-wise. Heck, even with a 95% on one of my last exams I was still below average (or that my 82% on another exam is below the average of 89%)!! Nothing stings more than knowing that, though you've passed and actually did quite well, many many more students did better yet. But medicine is so much more than book smarts, so much more than memorizing pathways and facts. And so far I've taken consolation in that.

There are students who fail so badly at medical interviewing that you pray they decide to go into radiology or pathology, where they never have to see patients face-to-face (or at least, not much). There are students who desire to do the least amount of work possible and aim for the "lowest tier" of medicine. And there are many who scoff at evidence-based medicine (EBM) - who scoff at epidemiological study designs, biostatistics, and valuable critical thinking and analytical skills. I have a friend who feels he'll be too busy to read medical literature when he becomes a practicing doctor, saying he'll only read the abstract and the conclusions of the studies and base his judgments on that; I worry for his future patients.

And then I realize that at the heart of the Mask of Medicine is an extension and amplification of the Mask of Caring. My roommate accuses me of "thinking too much" about medicine, about the issues that we may face in the future in clinical care (then again, he's just a bum). That I think about how I can better improve how I interact with patients; about how the ability to read, interpret, and critically evaluate medical literature is more important than any amount of biochem learned throughout a single semester; about how important cultural awareness is when dealing with a population as diverse as the US; about how "unfriendly" most medical practices are to LGBT persons (mostly unintentional); and about how we can all personally improve how we conduct care - perhaps I do think too much . . . perhaps I do care too much. I'm not saying I'm the best med student to grace the clinics - far from it. If there's anything this Masks shows me, it's that I've a long long way to improve in all respects.

The Mask of Medicine is all-consuming, it often dominates the majority of my days. Medicine, as preached to me by every physician I've spoken to candidly, is more than a job. The doctors who treat medicine as "just a job" are not good doctors and are rarely happy being doctors. This Mask is an exhausting one, but often also a rewarding one.

Last night I watched a gay-themed movie called Eating Out 3. It's a rather silly film - a bit over-the-top, but also hilarious and had some pretty hot scenes. Interestingly, all 6 of the main male characters are gay, and read an interview with them here. One of the main characters, played by Chris Salvatore, is simply gorgeous:

He's also a singer/songwriter with his own myspace and YouTube pages. I listened to some of the songs at those 2 sites, and actually liked some of them. So head over and listen to some tunes. And watch the movie if you're feeling up for a laugh and maybe a couple "awww" moments.


Anonymous said...

In regards to "more than a job", I think you're not just seeing a trait of a medical doctor, I think you're seeing the trait of any doctor. To really be a doctor in one's field and to care that much about a subject means you've invested much of your time and life into the field of study. It's not just a job, it's not just a career, it's a passion! It's the other lover your human lover will always have to compete with. So, in that regard, I can identify with and confirm what you're being told.

Jason Carwin said...

thanks for that post. It really gives valuable insight into the mentality of the next crop of doctors that this nation will see. Those of you studying right now will be the doctors that treat me in the future, and I found it interesting to look into your philosophies.

naturgesetz said...

That it is far more than a job, that it really isn't a job, is what we meant when we called medicine a profession.

I don't know if it is possible to find the time to read all the literature in medicine, any more than it is possible to read everything in any other field, but that is something you will find when you have an established practice. Your attitude toward the profession is what I'd hope for in any doctor who treated me.

But it is the caring demeanor that assures me I am in good hands.

Aek said...

James: You're probably right there. :-P

Jason: Well, I can only really speak for myself. Of course, some of this is certainly shared amongst the next crop of future doctors.

naturgesetz: There are people who do go into medicine and treat it as "just a job." One doesn't need to keep up with ALL the medical literature (because that's impossible), but one should certainly try to keep up with the studies most pertinent to one's own practice. It may be this screening technique vs. that one, it may be this drug vs. that one, it may be the efficacy of some vaccine.

Anonymous said...

Radiology is central to patient care and often the top students go into the specialty. Your view regarding it wlll change very soon. I guarantee it.
Plenty of patient contact , no patient bullshit

Radiology resident.

Aek said...

Anonymous: I won't deny that radiology is very important (though, I don't think I mentioned radiology in this post). I will also say that I have no intention of going into radiology. The few times I've walked into the radiology reading rooms I've felt oh-so-awkwardly out of place. I felt more out of place there than in the clinics.

But a good radiologist is pretty nice to have. :-)

Anonymous said...

Hi Aek: I come from a long list of doctors. My dad was a doctor, my mother was a nurse, my aunt was a nurse and my half brother was a doctor and a physiologist, md, phd. They certainly wanted me to be a doc. In 1932 or 1937, I can't remember, the AMA published in the journal that the profession needed "birth control." In other words, doctors could earn more money if there were fewer of them. The AMA journal uses the term to describe it as "medical economics". My brother was outraged, so I am told, and my mom and aunt openly disliked doctors, although mom was married to one. It was crazy. I was four years old in Chicago when my dad rolled out of bed with a heart arrest. Brother Howard was in the other room. Mother screamed for him to come to my dad and he just fell asleep. Dad was dead and Mom never forgave him In her mind he killed him. She used to say that there wasn't enough money in it for him. Shortly after that she demanded Howard sign a note for several thousand dollars so he could get through North Western in his zoology major, and earn his Ph.D. Look on google these: Fluid Circuit Theory, Maurice Fisher (head of his Ph.D. committee). He was super brilliant and a polished mathematician. Back in those days I remember him taking me through his laboratory with dogs on tables and tubes inside of them, ARGH. He worked like a fiend, never a rest and had a nervous breakdown. In those days, in the 40.s it was a disgrace for a doctor, let alone a researcher and professor to fall into a sanitarium, or even get ill. So he hung himself in his hospital room. One dead dad, one dead brother (who killed my dad, so my mom thought) and two RN's who hated doctors. Wow. Howard used to give me money on my report cards. He used to explain to the family that a kid had to be political to get into med school and that he was my avenue to North Western. Between the dead dogs, the dimes in the mail and the arguments over medical ethics I was never interested. But the story just now starts.

My mother became administrative nurse of Cedars Sinai Hospital in L.A. and ran the hospital and the entire nursing staff and even kept an eye on some doctors she thought were using, or were drunk in surgery. She waged war on the doctors. My aunt became head of nurses in Monto Sano hospital in L.A. She was less biased against doctors. Mother continued to be a very powerful person especially when cedars was becoming part of the U.C.L.A. Medical Center in Westwood, L.A. My mother and aunt had plenty of money and finally paid to get me a Ph.D in psychology. I wouldn't get into the battleground of medicine for anything. She was truly a kind woman to me, understood homosexuality but never wanted to say I was homosexual, loved my myriads of boyfriends and and all my lovers who came to the big house on the cliffs of Dana Point in Calif. Mom just loved gay men. She was wild and on top of this she adored queen Victoria! Loving always to me but stern with the hospitals. She found some doctors in Los Angeles that she knew from Chicago in training school. She would prescribe medicine over the phone and demand that they come to the house if we were sick. She called it medical ethics. That 's the history of my medical family. Mom forced my brother's estate and widow to pay her on the note he made him sign while he was alive.

I think that you will find strange happenings in the family backgrounds of doctors, M.D.'s. As a patient all that concerns me now is the loss of general practice physicians. Also, the breakdown in communication between patient, specialist and GP's.

Good luck, you have a sharp mind and you will do well. Your ideals are wonderful, keep them. CLYDE

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