Care in Health Care


A doctor did not cry, not if he/she was a real professional.  Rachel Naomi Remen, MD, was on the radio over the weekend.  When she studied medicine, physicians were taught not to respond emotionally to the suffering around them.  Physicians as scientists pay a terrible price for their objectivity.  Some of the highest rates of depression in America are among physicians.  

Dr. Remen said that physicians’ objectivity is an appliance that separates them from life around them and within.  Too often physicians  are wounded by their scientific objectivity.  Cognitive objectivity was the price of another dimension, and keeping a mental distance, for objectivity sakes.

There is a lot of burnout among oncologists, a profession that treats cancers day in and day out.  I could never do it.  Dr. Remen said burnout among physicians was due to the objectivity, from not immersing themselves in the grieving process.  Residency was an ongoing process that changes the vision of a young person and the way the resident thinks.  Over time, some thing fade, others are over-developed in medicine “until I forgot a lot of important things.”

The first response of a physician is to try to fix the broken, the ill.  When a doctor is immensed in suffering, he/she has a small strategy—to fix the broken.  I have a one friend who is a physician. He went through chemical dependency treatment about 8 to 10 years ago.  His problem was drinking.  I would see him weekly in the winter, but for 4 weeks he was gone.  He never really talked about his absence but in my case he knew that I knew.  Over the years, he has joked about the change where he no longer drinks, but other than a few people outside his family, few seem to know about those 4 weeks of his life.   From hearing Dr. Remen on the radio, I understand a bit more the struggles in his life.  Physicians seldom talk about their own problems, their pressures, outside their fraternity.  They pay a terrible price for their objectivity. 

A couple years ago I gave a book to my own doctor written by a Hinsdale, Illinois physician about his years as a resident at the Mayo Clinic in orthopedics.  After both he and his wife read the book, he passed it on to his daughter who is going though a residency in orthopedics.  Those residency programs are a lot more humane than they were 30 years ago.  But the real change deals with doctors who are immensed each day in suffering. 

There is a lot of burnout especially among oncologists.  It comes from a sense of failure over the inability to cure.  Medical schools have always been for the best and the brightest.  Many of these physcians have been good athletes, great competitors who are not used to failure.  And theirs is the disappointment on having a person die.  A patient who looked to them to be cured.  There is a tremendous validation for a physician each week to cure the sick.  These days people like Rachel Naomi Remen, MD, are offering grief theory to medical students.  Often in the past, when a doctor was immensed in suffering, he/she was left with his/her objectivity, with the restraints of time, to not really share in the grief of the patient’s family, to continue about his/her rounds, with a denial of his/her own loss with a patient’s death.  A doctor too often was filled with loss, with no room to care. 

The spiritual dimension of grief theory is now taught to medical students to remind them of their own power, and the human connection of medicine.   There was always a destructive dimension of science, in just the facts, without a purpose.  There was always a destructive dimension of medicine, of learning how to cure.  It was that dimension that seems to have accounted for the need for 4 weeks in the life of my friend to recognizing the limitations in science as well as him own.  There was learning that comes from suffering.  The power to be present in difficult times did have to be learned in order to be passed on to the young. 

( The Healer’s Art is a medical school curriculum which has been taught annually at UCSF since 1993 as a 15-hour quarter-long elective, designed by Rachel Naomi Remen, MD, Director of the Institute for the Study of Health and Illness at Commonweal at UCSF School of Medicine Professor of Family and Community Medicine.

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