February 21, 2024 | Rome, Italy

Revising “success”

By |2018-03-21T19:49:31+01:00April 18th, 2016|"Bio-Lingual"|
You walk a fine line in medicine, and emotional involvement with a patient can breach that line.

ight months into medical school is far too early to start becoming disillusioned. Yet that’s where I was headed. I’d entered medicine thinking I could help people. All too quickly, I realized that I couldn’t help those who resisted helping themselves.

It wasn’t something that occurred to me while studying biochemistry, anatomy, or cardiology. You don’t learn such lessons from books. I discovered it, painfully, while working with a patient who simply wouldn’t take medication.

“Take your medication.” It sounds simple, doesn’t it? You have a chronic illness. Pills can prevent that illness from getting worse, and also prevent disastrous complications. So why wouldn’t someone take a few pills? I don’t understand the logic, and probably never will. But for months I tried. I tried both to understand it and to fix it. For months, I smashed my head against a brick wall I couldn’t tear down.

I’m not the patient’s physician. I am a sort of medical student liaison. But I am part of the medical team, and as just as invested in the patient’s care as anyone.

Naïvely, I thought that if only I could come up with the right words, I could show that taking the medication was critical. That it was lifesaving. But nothing I said made a difference. Emotionally and professionally, I felt beaten down. I felt I had failed. By some measures, I had. In medicine, success is gauged in many ways, from saving lives to saving money. Much of the day-to-day success in internal medicine, though, is a numbers game: improving a patient’s numbers, and therefore his or her odds. Medically lowering a patient’s blood pressure, for example, means a lower risk of stroke. My patient’s numbers hadn’t gotten better — they had gotten worse. So had my patient’s odds.

Finally, at a loss, I went to a physician on the faculty at my medical school. She knows me, and she knows this particular patient too. Her years of experience in primary care allowed her to understand the frustration firsthand. Her advice was simple and elegant. What you need to do, she said, is “reframe” your notion of success. Consider this patient’s willingness to talk to you, to call you with problems, as success. There was a time when the patient didn’t have a positive relationship with anyone on the medical care team. Now the patient does. That ongoing dialogue — that’s success.

The reframing helped, though the feeling of culpability didn’t immediately dissipate. But the physician added something else, something I desperately needed to hear: “We didn’t expect you to fix [this].”

I still hope we can. Maybe one day, something will click and the patient will understand why complying matters. But I no longer define my success that way.

In medicine, you walk a fine line. You must maintain empathy without getting lost in it. Establishing appropriate emotional distance from a patient is not only a suggestion but also an imperative. That’s hard for me. I started medical school driven by idealism. I wanted to help everyone and thought I could. My very first patient has taught me otherwise. Some conditions simply aren’t fixable, and some people with fixable conditions won’t fix themselves.

About the Author:

Lorien Menhennett wrote the "Bio-Lingual" column from 2014 through 2018