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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
The Physician as Warrior
Does it have to be this way?
Treating without Caring
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John F. Clabby PhD, New Brunswick, NJ USA Licensed Psychologist
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We like having warriors in our professions. Dr. Roger Rosenblatt describes a number of physician warriors in his evocative essay. A series of physicians, even those who are good friends, tell him about his prostate cancer in most impersonal and detached styles. But we count on our health care providers to be tough, don't we? We want our doctors to cancel their plans to excercise or see their children play soccer so they can take care of our acute medical problems. We want our doctors to stay up late with expectant mothers and still be alert and skilled enough to provide good care. To do this, warriors have to cover-over some of their emotional reactions to their patients' suffering. They have to distance themselves from their own heartaches and the emotional wounds of those around them in order to complete complex procedures for us. The training begins early. Parents, teachers, coaches of children and adolescents seem to be in agreement about this. "Don't be a baby, you can handle it", or "Get back on the field, it's just a bruise." We continue this socialization in college, medical school, and residency training. Attending physicians understand the need for warrior physicians as they remind their young residents to toughen up, recalling how much rougher residency training was before these "new rules" came into being. Developing warriors does come at a price. Because warriors emotionally steel themselves from fully noticing the suffering around them, they may remain particularly unwise to the lessons that can be learned. Warriors tend to wait until tragic or near tragic life events happen to them before they make changes to improve their own health and well-being. Perhaps it just a part of the human condition. Dr. Rosenblatt, like many of us who have had scares in our lives, tells us that he will make life changes. With hard-won wisdom, he writes that he is planning to spend more time with his family. No longer will he form short-sighted judgments about people like he used to. He realizes that he "lives in the same shadow of mortality that falls on everyone". We can help warrior physicians find survivable ways to let in a little more of the emotional pain of their patients. Physicians would be less stuck in providing "routinized" statements of empathy. They would have more mutually healing connections with their patients. In allowing themselves to be more affectively impacted by others' suffering, warriors can still be tough but could benefit from the lessons of those smaller battles. They may not have to wait for personally life-threatening experiences to provide the wisdom they need to make healthy life changes for themselves, their patients, and their families. We have to take better care of the warrior physicians who take such good care of us. Competing interests: None declared |
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Francis Peter Kohrs, San Francisco, CA Physician, Life Long Medical
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In sharing information of a patient’s disease, supportive and therapeutic connections are hopefully created between physician and patient. Before tertiary medical centers Balint wrote that, “patients should be educated to mature responsibility towards their illness… with certain outlets for dependent childishness.”1 When the patient is also a physician perhaps all parties hold knowledge and psychological issues less important. “Purely objective,”1 treatment--as we know-- is not enough for most, but until we teach ourselves better it is likely the way it will be for the physician patient. 1. Balint M. The doctor and his patient. In The doctor, his patient and the illness. New York: International University Press, 1957. Competing interests: None declared |
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John G. Scott, New Brunswick, USA Assistant Professor of Family Medicine UMDNJ-Robert Wood Johnson Medical School
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I applaud Dr. Rosenblatt’s courage for sharing his intensely painful and personal experience. His skill as a writer is amply demonstrated in this well crafted essay. I am appalled, but unfortunately not surprised at the insensitivity demonstrated by his treating physicians. The hospital did no better, with systems designed for the convenience of those who work there, rather than those who are treated there. I think he lets both the doctors and the hospital off the hook too easily and I disagree with his suggestion that good technical care has to be delivered in an uncaring and distant way. William Carlos Williams addressed this issue far more eloquently than can I in an interview with Robert Coles: “Why should we always be told that the alternative is between a doctor who really knows what he’s doing, even if he doesn’t have much time to be with his patients, to talk with them and be understanding of them, and a doctor who has all the time in the world for his patients, but he’s a first-class idiot, and could end up being a threat to your favorite relative’s health, even life? I’ll answer that. It’s not a question; it’s a rhetorical statement meant to rationalize callousness and egotism!” “For crying out loud: who in hell wants a dope hanging around with a stethoscope? But why is this dope conjured up every time some swaggering tyrant or mean, cold son-of-a bitch, who happens to have an M.D. to his name, shows up and starts bullying people? …We do battle with the Devil himself, if you want to trespass onto theological territory. So, we’re gods for others—but we know how tinny we can be, or we damn well should know. I guess the raw truth is that the worst of us don’t know: the ones who strut and prance and con themselves and everyone else into thinking they are God’s hand-picked emissary, if not chosen successor.”1 Dr. Rosenblatt deserved better care, as does every patient victimized by this tyranny of medical technocracy. 1. Coles R. The call of stories : teaching and the moral imagination. Page 109-110. Boston: Houghton Mifflin; 1989. Competing interests: None declared |
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