Hello out there to anyone reading. I am a writer who focuses on Vermont, medicine, physicians, farming, gardening, and the lives and thoughts of women. I am working on a novel, Family Medicine, as well as a memoir, In the Country of Medicine. Even though I am a family physician myself, I know that there is a difference between medical treatment and healing, and that healing is a much more complicated process. I know, too, that medicine can cause harm, though it isn’t always clear to physicians that harm has occurred, how to recognize it, how to prevent harm from happening, or what to do about it when it does.
Many years ago when teaching a newly designed course in the Doctor Patient Relationship for first year medical students, I mentioned to them that doctors have as much power to cause harm as they have to do good. Immediately the room turned on me; these idealistic, hopeful students who believed that the very fact that they were going to be doctors must mean that they were good people, could not process the idea that they might do harm. Surely only bad people would injure someone. Surely all the hours of their lives they spent studying at the sacrifice of fun, friends, and family, must mean they were altruistic, well meaning, noble. Who was I to tell them differently?
In fact, I was a person who had felt the harm of medicine personally, not just through errors of commission, but through errors of omission, neglect, obliviousness. Of course, by medicine, I don’t limit my judgement to physicians alone, but to all medical personnel. Surely, as my husband sat writhing in pain recently at the local Emergency Room as he experienced his first kidney stone, the intake nurse could have advocated for him to be seen more quickly; the doctor who saw him could have ordered an IV and pain medication; the nurse in the ER could have arranged for him to be monitored in the hallway even if a room wasn’t available, rather than send him back to the waiting room to suffer without treatment or attention. I had presented my concerns to these people, mentioning that he might have a kidney stone, or he might have an acute abdomen (a term that signifies a true emergency) caused, perhaps, by an inflamed appendix or diverticulum. I thought that my input would encourage them to listen, to attend, to take his case more seriously. It did not work. As a wife, should I have behaved differently? Should I have yelled at the nurses? Demanded treatment? Even while knowing that behavior would get us both labelled as trouble makers and drug seekers? In the end he did receive fluids and morphine, which he accepted even though by that point his pain was changing and the stone had nearly passed. The final two or three hours of the ordeal were almost blissful for him, as the pain, nausea, agony, all went away. He came home later that day symptom free, the diagnosis of kidney stone all but certain.
What is the price to an individual of medical indifference? My husband brushes off that ordeal, reminding me it is over, as we make our own plans for dealing with a possible recurrence (maybe getting his doctor to write a couple of prescriptions for us to keep at home just in case. I wonder if she would even do that?) All the while, the memories of that ordeal have nagged me. I am reminded of other instance in my life when medical care has been less than caring. When my mother developed seizures as a teenager in the early 1930’s, a neurologist decided the best option would be to irradiate her ovaries; if she didn’t have menstruation, she wouldn’t have seizures. I came close to never existing until my grandmother cancelled the procedure the day before it was scheduled. Or when my father was in the hospital after a total knee replacement; he was bored and antsy, as a farmer unable to be outdoors is apt to be, so wheeled himself around the hospital in a wheelchair, his newly operated leg outstretched. As he returned to the wing where his room was located, the chair malfunctioned, his outstretched foot slammed to the floor, his new knee suddenly locked straight from hyper extension. As bad as the initial pain from the surgery had been, this pain was even worse. Yes, he was given pain medication before and after the second surgery to repair the malfunctioning joint. But no one apologized for the crappy wheelchair that collapsed on him or reassured us that the wheelchairs would be examined and repaired so it wouldn’t happen to another patient like him. No one apologized for his requiring a second surgery, or the increased bill and operative risk that resulted. In fact, the staff was hesitant to explain anything that had happened, perhaps afraid of a lawsuit. Yet how comforting it would be to have someone, anyone, acknowledge my father’s suffering.
Many years later, as that knee replacement started to fail, as his other knee became nonfunctional, my father refused to even consider undergoing another knee surgery. The outcome of that first experience was so bad in his mind he would never take the risk of going through it again, no matter the degree of disability and discomfort he experienced. Technically no one did anything wrong from a strictly medical standpoint. Yet everyone was complicit in worsening his suffering.
So I guess my point here is that medical care doesn’t always seem to have a lot of caring associated with it. I don’t know that this is a new thing. And maybe the myth of the caring family doctor of old was just that, a myth. Maybe the few doctors who were humane, attentive, caring, as well as medically knowledgeable, set a standard no one else can reasonably reach. I don’t want to believe that, of course. Instead, I believe that a medical education system that cares about its trainees is more likely to produce doctors and nurses that care about their patients. Currently, our medical education system is generally cold, inhumane, often abusive. The products of that system likely haven’t the capacity to care about others, their own needs being so neglected.
Hospitals care about causing harm in that they risk losing funding if data about patient outcomes is unfavorable. They launch initiatives to encourage hand washing and sterile technique, which have some effectiveness. In hospitals where staff and physicians voluntarily participate in literature reading and discussion, there is improved camaraderie and respect among the professions, and, interestingly, improved outcomes for the patients. Sadly, though, efforts to improve hospital culture including improving mutual respect among staff and physicians is not universally attempted or even recognized as important. Instead, hospitals worry about profit margins, staff worry about cutbacks, doctors worry about productivity, and patients – well, they should worry about all of it. But in the end, patients are just numbers, bodies to fill beds, insurance numbers to be billed, data points on a spreadsheet.
No, I don’t have any glib answers to all of this; as we Americans struggle to understand our current government, as we struggle to figure out how our health care system might improve and how or why political forces seem determined to make it get even worse, the last thing that seems possible is to make health care more humane and caring. Still, by talking and writing, perhaps I can be a tiny reminder of what medicine is supposed to be about – not just treatment and cures, but also healing and caring. Instead of pretending our scars don’t exist, I tend to look at them to see how they happened and how they might be avoided next time. I want to hope that there can be a side to medicine that cares about doctors and patients alike, and that caring physicians and other health care providers can survive in this hostile climate.
And when I can’t take thinking about medicine any more, then I’ll write about my garden, my writing, flowers, and whatever else comes to mind. Thank you for joining me on this journey.
Harriet Anne Squier 