You write that many students have their idealism shattered in medical school. How can we better support their emotional health?
Not every student who comes gets spit out as a callous, jaded cynic, but a not insignificant number have some lasting damage. Drug and alcohol use is very high among physicians. Suicide rates are the highest of any profession. I think that this is the kind of thing that we can’t address in a classroom or in our mission statements. If you hear it in a lecture hall, it only has minimal impact. But if you see your attending physician behaving in a way that makes you say, “ah, that’s how I want to be as a doctor,” or you see someone behaving in a way that makes you think, “God, I would never send my mother to this doctor,” those are the behaviors that create the environment in which our students train.
Should medical residents be required to speak with therapists?
I don’t know if mandatory therapy would go over so well. But what if one noon conference per month were devoted to this? Not when they send in a gray-haired social worker with a British accent and a pizza pie to talk about feelings, but when a department chair or division chief—someone in a white coat who does actual doctoring—sits down and says, “Gosh, here’s a big error I made,” or “This was the roughest part in my training.” That has resonance for a student.
What’s the role of the apology in medicine?
Many doctors are afraid that if they apologize for an error, that could be used against them in a suit, which is a well-founded fear. But part of this is moral decency. When we mess up, we need to acknowledge it. For doctors and nurses, acknowledging errors is a big part of healing ourselves. And studies show that patients are much less likely to sue if their doctors apologize.
What can a patient do to ensure a productive, satisfying doctor’s visit?
One thing a patient can do is prioritize concerns. When a patient comes in with 50 complaints at the same time, it’s not physically possible to give every issue its due. But if they say, “I have a lot that’s on my mind, but here are the two things I want to make sure we get to,” that really helps me.
You write about your early career in such vivid detail. Did you keep a diary?
I wish. I had a colleague in residency who kept a diary, but I was, I think, lazy. I also think it was too close to the emotional bone to write about at the time. I’ve probably forgotten the 10,000 blood pressure checks I’ve done, but the truth is you don’t forget patients that have these intense experiences with you. When I said to doctors, in interviews for this book, “Tell me what made you the doctor who you are,” not one person said “Harrison’s Principles of Internal Medicine.” They all talked about patient experiences which they could recall in incredible detail.
Photograph by Joon Park