Tuesday, October 19, 2010

Cynicism and what it does to you

I've been called cynical by some of my friends. I counter that by saying I'm not cynical, just realistic. I'll admit though that yeah, in some things, I can be a bit of cynic. But my cynicism or lack thereof is  not the point of this entry. This is about cynicism in the medical field.

It appears that something happens when people graduate from med sch and become residents. They get tired, they see the same stuff day in and day out. Unfortunately they are confronted by less than stellar behaviors from pts. They work long hours, get paid next to nothing and are the workhorses of hospitals. They're very tired (did I say that already?) and their buttons are much more easily pushed. As a result of all this, residents, I find, have little patience for some patients. Especially the ones who represent the "typical problem patient" for which ever specialty is involved. It may be the alcoholic who gets discharged from alcohol induced pancreatitis, and then returns to the hospital a few days later with the same problem. Or one who is convinced that he has some dire surgical emergency that never is. Or the one who comes and tells a sob story about having a pain or panic attack and only wants to abuse prescription medications. And on and on and on....

After seeing enough of these patients, the residents quickly lose their sympathy, and quite frankly have better things to do than to aid such behavior. So they send these pts out as quickly and efficiently as possible, and move on with their days. What happens then, when a patient actually has legit pain from cancer mets? or when a patient's pancreatitis is not from alcohol because they've been sober? Or the patient has undiagnosed or untreated psychiatric issues? or the patient goes home and tries to harm themselves? Unfortunately, these patients, with real and legit needs get shafted because of the actions of others- and in fact, sometimes due to their own prior actions.

The med students are the suckers who believe any and every story. In a sense, they're still fresh and new and unjaded. The attendings are removed enough and balanced enough that they can be a little more objective in recognizing real from unreal, and are more likely to give the benefit of the doubt. And even when the attending knows that this patient is faking or making things unnecessarily difficult, they have the foresight to see why this is and sometimes they address it.

In the end, a lot of different factors go into shaping a patient's care. Sometimes the cynicism is undeserved and represents a barrier to rapport building and sometimes to effective care. Other times, the cynicism is well deserved and every one breathes a sigh of relief when the pt is gone.  Eitherway, the task for the medical team is to remember that every pt needs the best care and needs an equal chance. But seriously, the medical team is made up of human beings, not cleverly trained androids who just churn out cures. I wish there was a more just way of rationing care and keeping people who abuse the system confined or contained. Then people who dont abuse the system wont have to pay for the misdeeds of others who do.

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