Losing Our Compassion

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I think that the vast majority of students enter medical school intending to come out as not only knowledgeable but also compassionate doctors. My fear is that the medical culture in which we are learning takes some of our innate compassion away from us.
As medical students we are taught pattern recognition in diagnosis. We should have in our heads numerous lists of history and examination findings related to each diagnosis. We then have to match these lists against the list from the patient presenting in front of us. Recalling these lists as well as other lists of questions to ask or examinations to perform occupies the forefront of our minds, and all too often the last question to be asked before presenting to your senior is, “Oh, by the way, can I grab your name?”
Often I find that compassion has to be weighted against the need to learn. I used to think that the patient’s best interests should always be the priority, but now I am not so sure. Is it okay to sometimes put the patient in an uncomfortable position to further your learning, or to demonstrate to your instructor that you know the content? Two examples come to mind.
The first was during a tutorial when I was part of a group taking a history from a patient with recently diagnosed acute myeloid leukemia. The middle-aged man had broken down into tears as he talked about how his family had been coping with the news of his illness, especially his young children. With the patient still visibly distressed, our instructor asked the patient to show us his scrotal lesions, as it would be a good learning opportunity for us. The patient said that he would rather not at the moment and asked, “Do I have to?” The instructor considered this for what I felt like was too long before I butted in and said, “No.”
The second example occurred when I was asked to talk through a general inspection of a patient at the bedside. The patient was visibly overweight, but I did not want to articulate this in front of the patient. The instructor kept asking questions and hinting that I should comment on the patient’s weight, but even using a more medical description such as “central adiposity” seemed too impolite. The instructor eventually decided I was incompetent and made a remark about weight himself in front of the patient. These situations, and others like these, make me uncomfortable. However, what scares me is noticing behaviors that are uncompassionate and realizing that they are not making me as uncomfortable anymore.
As we progress through our medical careers, the lack of value I see being placed on compassion in the hospital will only be compounded by increased study demands in our clinical years, and by decreased time and sleep in our junior doctor years. I just hope that my values can stand up against the environment in which I learn, and in which, one day, I will work.
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