“I just need you to care!” I was a chief resident, and I was yelling. The source of my righteous indignation is a long clinical story, but it boils down to the following principle: my patient’s concerns had been disregarded and they were sent home from the ER without a proper workup. It was now several hours later, and between waves of rage I wondered what my patient was doing at that moment. Maybe they were just walking back in the door of their house alongside the loved one who had driven them, still in pain, and now exhausted from having made a fruitless round-trip drive in the dark. I imagined that they might feel angry and abandoned. As my own anger mounted, I yelled the conclusion of this “learning opportunity” at the intern who had downplayed my patient’s needs: “You obviously can’t learn anything because I can’t teach you to care!”
Today, as an ever-evolving attending surgeon who now sleeps regularly, I understand that yelling and shame are not valuable teaching tools. Though my methods have evolved, I still try to convey to trainees the two most important things they can do to be good doctors: 1. Be present 2. Care. Much of the time just showing up, listening to the patient, and trying your best to see them as a whole human will lead to correct diagnoses and mutually agreeable treatment plans. The job can be heavy and overwhelming, but being fully present enables us to care about the patient while caring for them. Being present with unfatigued compassion enables the personal fulfillment that comes from helping others.
This fulfillment is not accessible if we come to work morally injured or burdened by our own bitterness; then we are at risk for an even more dangerous problem: apathy. Some think that apathy represents a lack of altruism. However, in this age of decreasing profit margins and increasing patient complexity, apathy is a valid response to the repetitive harm perpetrated by institutions that take without giving. Unsupportive systems turn doctors into professional box-checkers, and exchange diligent care for things that look good on paper without doing good for a person. These types of systems can fatigue the compassion of even the most noble physician. Apathy has consequences for our patients too, often sparking mistrust and driving them toward predatory peddlers of farcical remedies like horse serum and vaginal jade eggs. Even if we offer perfect medical advice, patients do not care what we know until they know that we care.
Going back to that fateful morning during my chief year: I called the patient, apologized for their experience the night before, talked through their symptom management, gave them warning signs to look for and a plan if they appeared, and followed up with them shortly thereafter. The patient expressed frustration about the ER trip but gratitude for our ongoing care, and determination to recover from both this most recent setback and the overall disease. Little by little, the patient did get better. Several years later, they reached out to let me know that my caring during the low points gave them comfort and helped them believe they could recover. While I do regret most of the times I showed my concern for patients by yelling at my co-workers, that intern gave me grace and went on to care about and for many patients very well. So, as we prepare for a new academic year, I hope we can all remember that most of the time, our patients, our colleagues, and especially our interns, just need us to care.
Susanne Warner
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