Tuesday, March 23, 2010

That Other Purpose

For what purpose do we practice medicine? To better ourselves or to help others? Trick question: it's both.
Anyway, last night I went to a HIV/AIDS Awareness Night event that one of the student groups organized. The ID (infectious disease) doctor, Dr. P, I shadowed was there moderating the panel Q&A, and one of the HIV patients I saw while shadowing was there on the panel! It was a really well-organized event.

First there was a short 20-minute clip with two interviews of young people (early- to mid-2os) living with HIV while we got dinner. Then, Dr. P introduced himself as well as the 4 HIV patients on the panel and another ID doctor. They each introduced themselves in turn and the remaining hour-and-a-half or so was simply Q&A.

To hear what these patients went through, and still go through, was strangely motivating. To hear their stories, their ups and downs, their will to move on - it was all pretty incredible. 2 of the patients were diagnosed in the 1980s and the other 2 were diagnosed recently (within the last 10 years). As they recalled how they found out about their diagnosis, I can't forget the last patient (an African-American male) to speak. At the time (in the 1980s), he had divorced his wife and was raising his kids as a single parent. His doctor, a white male, thinking himself a savior (the patient's words), came to his door and told him the diagnosis. In front of his children. To say the least it shocked all of us that a doctor would have the audacity to do something to outrageous.

Throughout the panel discussion, the singular thought throughout the room of med students was: "How can we be better? How can we do better? How can we make things better for our future patients like you?" To say I learned a lot from this 2-hour period might be an understatement (certainly, the things I learned would stay with me longer than, say, lung physiology). I admire the patients for their courage to speak to all of us. I admire Dr. P for being there for his patients (I think they were all his patients) and the relationship he was able to develop with each of them. There were times were I felt like I was moved to tears, especially when one the patients told us about her experiences as a camp counselor for pediatric HIV patients.

Dr. P will say something that I think I'll remember for quite some time: "Even today, even though things are better, there's perhaps no other disease that still carries the stigma that an HIV diagnosis carries." And it's true. Even medical professionals, medical professionals, sometimes react abhorrently when hearing their patient has HIV.

After the event was over, I went down and talked to Dr. P, to tell him how much I appreciated him being there and how highly I thought of the event and the patient speakers. I also talked to the other ID doctor. We got talking on public health and all the things being done and researched with regards to a vaccine or cure against HIV. To talk about the vaccine studies and the "test-and-treat" model that's being proposed to "treat away the epidemic" was refreshing. Needless to say, it felt good to talk almost on par with a doctor on such things. He also regards the field of infectious disease as "primary care on steroids." I'd say I agree with that. :-P
Today, I went to a lunch talk hosted by another student group. A speaker with Tourette's syndrome and Hirschsprung's disease came to give a talk. One of my labmates is apparently good friends with him, as they went to undergrad together.

Anyway, he talked about his life experiences with these two diseases as he tic'd away (physical and verbal tics). He was quite the charismatic speaker. He had aspirations to become a pediatric surgeon (in the footsteps of his pediatric surgeon who saved his life), but then realized that he could probably help many more people by doing public speaking like he was.

He, too, said something that I'll remember. There are things that doctors should probably do that med school doesn't prepare for. It doesn't prepare med students to care for people as whole people. Almost every class we have is a "basic science" class - biochem, anatomy, physiology, neurosci, pathology, microbio, pharmacology - but few classes prepare us for all the other things involved with a patient, that definitely impact his/her care. It doesn't teach us how to break the news of a HIV diagnosis, or how to counsel a HIV patient through stages of depression and grief, or how to help a middle-schooler with Tourette's make friends or talk to others about having Tourette's. We're taught how to break patients down to symptoms and pathologies, even while being told that it is indeed a person we're treating and not "HIV" or "Tourette's."

He left us with an acronym he came up with: HAATS. Humor. Acceptance. Advocacy. Tolerance. Support. Humor is a wonderful tool and perhaps one of the best coping mechanisms; laugh at oneself and at others. Acceptance of oneself (and others) with a condition or some difference. Advocacy for oneself or for others; so many times patients don't have an advocate for themselves, and so that role falls to the physician. Tolerance of others and that not everyone can or will understand - and that that's okay. Support from friends, family, medical staff, etc are critically important.
So after reading those rather length accounts above, I ask again: for what purpose do we practice medicine - to better oneself or to help others? The answer's the same still. But I think it's worth remembering that other purpose. And not just for health professionals, but for all of us.

And if you want to read more about the Tourette's speaker, you can go to his website here at: www.whatmakesyoutic.com.


Biki said...

This is the best post you have ever written. Your passion comes thru so crystal clear. I like seeing you passionate, expressing your love of and for medicine. I have always felt that to be excel at some thing you need to be passionate about it, and if that's the case, you should be a fabulous doctor!

Anonymous said...

Working with HIV patients can be quite the eye-opener, and quite the lesson in love and acceptance (and not freaking the hell out!). So many times I think they must get treated like the modern day lepers, and it takes a significant amount of effort and will power to not want to avoid an HIV patient like the plague. Having been on the end of the shocked other, and having worked with HIV patients closely, I can only just begin to imagine what they have to go through.

I like your quote here. "We're taught how to break patients down to symptoms and pathologies, even while being told that it is indeed a person we're treating and not 'HIV' or 'Tourette's.' " This is part of the dehumanization process I talk about in my blog. Part of academia's breaking every person or human thing down into so many parts the good of the whole is completely lost. It's particularly insidious when the field of study directly involves human subjects. I'm glad you can see it happening, it's the only way you'll be able to fight it when it comes up.

naturgesetz said...

The problem is that it's not just either/or. When you treat the patient you are fighting the disease or condition.

So you need both the knowledge of what effective treatments are available for HIV and the ability to care for those with HIV (or any other medical issue). I wonder if people still use the phrase "good bedside manner" to describe the latter.

I've been fortunate that my doctors have all dealt with me as a person. Based on that, I think the vast majority of the profession are able to treat the person as a person. I'm sure the reminders during med school, as well as the example of the doctors you shadow, help with that, but I also think it must be that most people who go to med school genuinely care about people.

Aaron said...

i think working with any form of marginalised "community" is an eye-opener and it really makes us open our eyes to what we take for granted and how sometimes we do things we don't intend to but it happens anyway. good work, Aek!