Saturday, January 28, 2012

Privilege & Entitlement

"The moral test of government is how it treats those who are in the dawn of life, the children; those who are at the twilight of life, the aged; and those in the shadow of life, the sick, the needy, and the handicapped."
I came across that quote in this article, Addressing the needs of the disadvantaged in our health system. The words themselves struck me and the article is well worth a read (it's by a med student).

I linked that article to a friend and she shot it down as overly idealistic because people will find a way to take advantage of and manipulate the system. Then people will begin to feel entitled to the help from the government and stop trying as hard to pull themselves out of whatever situation they find themselves in. The public health aspect of me balked. She turned it back on me and remarked that I probably felt more entitled than her, and that her boyfriend almost certainly feels more entitled than either of us. I was confused. She stated that I must feel entitled to be paired with good physicians as my clinical teachers and that I expect certain things to happen or else. I was taken aback. This then became a philosophical discourse of sorts.

I have never really felt entitled to much past high school. I learned very quickly that things in life must, more often than not, be earned. I have never felt a sense of entitlement in med school. Whether or not I am paired with a good physician or not is purely luck (that said, I've been pretty lucky lately).

Every moment I have time to give pause I am filled by a sense of privilege. Truly, being a doctor is a privilege and one of the highest out there. In how many other professions can you ask someone to take off their clothes and allow you to touch them in ways that would otherwise get you arrested? In how many other professions will someone come to you and ask you to cut them open and do what you will inside them without getting sent to jail? In how many other professions can you ask someone about the whole "sex, drugs, and rock-and-roll" without getting them arrested?

I am aware that every time I walk into a patient room, I have mere seconds to earn their trust. It's an interaction that takes place within a few seconds' time, but it is so critical. With adults, this is an introduction and a shaking of hands. With kids, this is more subtle but can be sensed by the look in their eyes (and whether they give you a high-five or fist-pound). With newborns, it's a settling back into a calm. I am motivated by a sense of awe for the practice of medicine. For patients to allow me to listen to their stories, to examine them physically, to place trust in my words (as a M3 med student), to consent to have me assist in their surgeries and be elbow deep into their abdomens - I'm not sure words can express the sense of gratitude and privilege one can feel.

Unfortunately for many of my peers, the rigors of the training and the complexities of the patients out of our control have jaded them. To quote Dr. Walcott in the movie, Patch Adams:
"Our job is to rigorously and ruthlessly train the humanity out of you and make you into something better. We're gonna make doctors out of you."
In a profession that deals with humanity, how have we allowed it to smother out our own humanity? It's a curious thing. I would be lying if I said I haven't had my moments when I wondered why I even bother to help some patients, knowing that they will not or cannot help themselves. I would be lying if I said I haven't ever been pissed at a patient when things took a turn for the worst.

But thinking back to WHY I'm here in the first place brings me around full circle and sustains me. Everyone has a reason for going to med school, some of them better and nobler than others. I believe those who hold onto their reasons and do not lose sight of it are best able to make it through without become (as) jaded.

Well, this post has been rather long and I'm not sure it makes a whole lot of sense. I'll have more to say after my exam on Monday. Eep!


Uncutplus said...

Aek, pardon me, but your humanity is showing! Physicians should be allowed to get to know their patients, so that they can treat them holistically. The main problem is time, with so many patients to attend to. My own physician during my last visit took the time to inquire about my farm, and briefly discuss two historical biographies he had just read, because he knows my interest in American history.

Speaking of entitlements, politicians have it all wrong about Social Security and Medicare being entitlements. Through my working career, I have had large sums of money deducted from my paychecks for these "entitlements." I have been collecting Social Security for almost 7 years now since age 63, and I keep a spreadsheet of what I paid in versus what I get from the government. Doubtfully, I will get back all that I have paid in; the same is true of Medicare. On the other had, I get a small pension and health benefits from the state that I worked for, and my spreadsheet shows that I have greatly surpassed what I paid in, in the benefits that I have received. In the case of the state, it has been an entitlement, but not in the case of the federal government.

R said...

Good post. Most of our clinicians (especially GP's) here in Australia heavily emphasize that prevention is key, which of course probably includes the provision of proper social services.

fan of casey said...

Aek: Please don't lose your humanity as you progress as a doctor. You can find a happy balance between doing it for noble reasons as much as some do it for prestige and financial reasons.

My older brother is a surgeon and is doing very well financially. I'm also glad that he has not let being a doctor get to his head and think of himself as all high and mighty looking down on others; he is very grounded and down to earth just like a regular guy but doing extraordinary work helping people and saving lives.

As to your friend's analysis, all government programs will encounter people who try to game and cheat the system. Should we eliminate these benefits for the vast majority because a few cheat? That is just too simplistic -- we need to run the programs a lot more efficiently. But as many news stories expose, both beneficiaries and some providers cheat the system -- because there always will be dishonest and selfish people.

Anonymous said...

that "moral test" you quote should
apply to the pre-dawn of life, too
-- i.e., embryonic life -- but it

Aek said...

Anonymous: Using the word "should" assumes several things, none of which I'll go into here because it'd be sufficient to be a post all on its own.