Professionalism key to care of difficult patients

Ethics Forum. July 3, 2006.

Scenario: How can you care for a patient for whom you feel a total lack of compassion?

Reply:

That question prompts three others.

If we waited for children to feel genuine gratitude for birthday and Christmas gifts and only then tried to teach them to write thank-you notes, the habit of expressing thanks would probably never get passed on to the next generation. Similarly, we require that medical students take histories and do physical exams when nine-tenths of what they hear and observe makes no sense to them.

We trust that as they proceed, gradually, things will start to fall into place and make sense -- just as has happened with generations of previous students. If the new students do not begin to "perform" the rituals of the history and physical fairly early in their training, we fear that the moments of gradual enlightenment will be postponed.

The science writer Nicholas Wade once said, "All medicine is a form of theater." Performance is often misunderstood as fakery. Certain things in life become true because people possessing the authority make it so. For example, if a jury finds me guilty and a judge sentences me, I am, at least for the time being, a criminal. In some sense, whether I actually committed the crime I am accused of is immaterial. Making ourselves behave "as if" may be the best way in the end to develop the genuine sentiment or the relevant process of thought.