Jul 13, 2010

Should Fear of Patients Keep You From Medicine?

The first of the series: Should I Become A Doctor?

A confused premed writes Doctor D for advice:

"I really want to be a doctor, but I have a fear of sick people. I don't mind needles or blood and guts, it's just people being physically sick that I am horrified by. It's the only thing holding me back from applying to Medical School. Is this something you think I can overcome?"

Excellent question my young friend!

The good news is that you aren't the only person who feels discomfort in the company of ill people. Many people feel this way to some extent or another. Ask any chronically ill person and they'll tell you how often people squirm in their presence. If you want to be a doctor you will eventually need to work comfortably around sick folks, but first lets examine why people feel this unease...

Why would you be horrified by sick people?

1) You're afraid you will catch their disease.

I suppose this is an understandable concern. But many illnesses aren't contagious and most of the others can be easily prevented with proper hand washing and immunizations. Doctor D has caught more things from his preschooler than he ever caught from patients!

But... I suppose there is always a small chance you will catch a bad illness from practicing medicine. If you aren't willing to take this risk then you should probably stay away from medical school.

2) Ill people remind you of your own frailty and mortality.

If you want to blissfully imagine you will live forever in perfect health the existence of illness in others is a painful reminder of reality. If fear of sick people is an extension of your personal dread of death then by all means stay away from medicine because every day at work will terrify you.

Believe it or not, a lot of narcissists with the this issue are drawn to medicine because they want the MD as a status symbol. They leave medical practice when they realize that the presence of suffering kills their hedonistic buzz. Good riddance!

3) Ill people make you uncomfortable because you feel their discomfort.

Human beings are social creatures. We all to some extent experience the world through the experiences of others. When we are around people who suffer—if we are at all feeling persons—we tend to feel a small amount of their pain.

This is Empathy, and empathy has motivated some truly amazing people to choose medicine as a career. Rather than avoiding the ill because of the sympathetic pain they feel, many empathic people want to help those who suffer.

If you are disturbed by ill people because you feel their pain, then you can become an understanding doctor goes the extra mile to help. We need more doctors like this.

If this is you, then you could have the makings of an excellent physician!

"Trust me kid, I'm more scared of you than you are of me!"

Disclaimer: Empathy Can Be Handicap Too!

If you feel so strongly for ill people that you turn into a puddle of ineffective mush when confronted with the suffering of another person then you aren't much use. Sick people come to doctors for help, and sympathy is an extra—a good extra, but only if it comes with professional help and skill.

Can you calm your emotions enough to think clearly and help people who are suffering greatly?

Also, empathetic doctors tend to get burned out. It's wonderful that you feel for your patients, but you have to realize that disease always wins in the end. You will lose a lot of patients. You will be unable to cure a lot of diseases. If your motivation for being in medicine is helping people's suffering you will have a lot of days you want to just give up. This is called compassion fatigue and it is the bane of kind doctors everywhere.

Can you keep doing your work with sick people and still care even when you lose again and again?

If you can maintain your empathy despite these obstacles you may just find that your initial anxiety around sick people made you into an even better doctor!

What do you think?

Patients: Would you be comfortable seeing a doctor who still sometimes feels uncomfortable around sick people? Would you go see our young premed once she graduates from medical school?

Med Students and Doctors: Have you ever overcome a dread of ill people?

PreMeds: Dr. D loves bringing premeds to the hospital and answering their questions about medicine. He always gives it to them straight about what it is really like to go through the training and then practice. So send him more questions!


Anonymous said...

Just remember, the patients are more afraid of you than you are of them!
eh, never mind, that kind of advice never helps in any situation.


Alexandra said...

I grew up in hospitals, so I am already comfortable with the fact of my own mortality and being around other seriously ill people doesn't phase me. One of the things my patients say they like most about me is I don't treat them like they're sick. I talk to them like anyone else, and treat their complaints as an ordinary part of the conversation. I won't say that I haven't cried when I've lost some patients, though. Mostly I'm just upset that they're gone.
I'm a nurse though, not a doc. I guess a lot of the same things apply though.

DrSnit said...

Rachel Naomi Remen, M.D. speaks to compassion fatigue and burn out in her work and lectures with med students. She also writes about it in her book, "Kitchen Table Wisdom: Stories that Heal." It helped me understand my doctors more - as well as my own healing process because she spoke as a physician who has a chronic illness.

We are all healing because ultimately we will all face death - of ourselves and our family and loved ones. So yes - I am OK with a doc who is still growing in some areas as long as we have a supportive relationship with each other based on TRUST and mutual understanding.

Anonymous said...

As a patient, I will always prefer a doctor who can show some empathy and compassion toward me. I'm not sure I've ever been to a doctor who was scared of me (I have rheumatoid arthritis, a frustrating and incurable disease); if I have, they've covered it well. I have been to doctors who showed no interest or compassion toward me, though, and they are no longer my doctors.

Good luck to the scared pre-med student, whatever decision she makes. Perhaps a career in medical research might work for her, if she cannot overcome her fear of ill patients.

Anonymous said...

“You can hold back from the suffering of the world . . . but perhaps this very holding back is the one suffering that you could have avoided.” ---Franz Kafka

I used to have the happy fantasy that all doctors knew how to handle the suffering of others, and that this secret wisdom kept them from ever feeling upset. Well, now I’ve been seriously ill for awhile, and I’ve had the chance to see that doctors struggle with this all the time. If I did not see doctors who are sometimes uncomfortable around illness, there probably wouldn’t be any doctors left for me to see!

A doctor’s discomfort in reaction to my illness doesn’t bother me. It seems normal. In fact, it’s kind of distressing when my suffering does NOT seem to bother a doctor. It’s always kind of hard to have a doctor who feels locked up and robotic. Maybe they are the most frightened ones of all.

It honors me when a doctor is upset on my behalf for a moment (a doctor isn’t ALWAYS in a crisis mode where swift action is the only good response). It acknowledges that I matter and that they want me to be well. Those are good things to articulate to a patient. To me, it’s okay if doctors show that they feel rotten or are scared or frustrated; I think those feelings are inevitable when things aren’t going well, and expressing them doesn’t have to involve a lot of drama or hysterics. I get the impression that some doctors feel a professional obligation to never shed a tear in front of a patient or show sadness or dismay (or, worse, to never feel anything in the first place). Or maybe they think it’s dangerous because they might get overwhelmed and not be able to drop it and move on with a clear head. . . . Admittedly, none of this is easy.

I think the pre-med student who raised this topic is way ahead of the game to be aware of these sorts of feelings and to be grappling with them already.

Anonymous said...

Something that I have learned as a medical student is that your own emotions can be a reflection of the emotions of those you are working with. If you are experiencing this type of uneasiness, then you can harness it as a useful tool. It can help you to seek to make your patients more comfortable, and will in turn strengthen the therapeutic relationship.

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