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!

Hurting My Patients

An email to Doctor D:

What does it feel like to cause pain or disfigurement to a patient? Is it troubling or do doctors not let it affect them?

Believe it or not, most doctors are not sadists.

Hurting patients is distasteful to those of us who went to medical school because we wanted to "help people."

But the fact is that the really cool gadget that Dr. McCoy waves over sick people to fix them hasn't been invented yet. "Dammit Jim, I'm a doctor not a butcher!" Unfortunately, for the foreseeable future even high-tech medicine will involve some butchering.

People come to Doctor D feeling rotten and I sometimes stick them with needles, electrodes, blades, and tubes which at least in the short run makes them feel worse.

Sorry, I know, it sucks.

Doctor D fully realized the cruelty of his profession as an intern when he was performing a lumbar puncture on a squirming, screaming 2 year old with meningitis. The terrified kid couldn't understand why sticking a needle into his spine was required. He just thought we were torturing him. It sucked. That day D wished he had chosen another profession.

But young Doctor D got over the trauma he caused. The fact was that the lumbar puncture helped save the kid's life. Many of the painful things we do save lives, so we grin and bear it.

After a while we get used to hurting you:

It doesn't help patients for doctors to get emotionally distraught every time we cause pain. You want me thinking clearly so I can do procedures quickly and efficiently, with as little pain as possible. The doctor who hesitates to do an urgent painful procedure can be dangerous to patients.

Empathy must kept in check by necessity.

But occasionally the doctor gets too hard... forgetting your pain altogether and focusing only on the job.

Or even worse, we enjoy hurting you. It's easy to feel for a helpless toddler we have to hurt, but a whiny grown up who asks to be "knocked out" just to get an IV and has more tattoos than skin is a lot harder to feel for. Patients who thrash around can be dangerous to work on because needles and scalpels get knocked all over the place. "STFU and be still!" We sometimes even fantasize about performing painful procedures on belligerent patients.

Our work in proximity to so much suffering has a natural hardening effect. Doctors must constantly be wary lest we become cruel.

I believe that we can find a middle ground in which we perform the difficult task of hurting to heal without losing our compassion.

If I must cause pain adding kindness and understanding can sometimes be more therapeutic than morphine.

Doctor D always enjoys hearing your stories and perspectives in the comments.

What are your experiences with doctors causing pain? What was done well? What was handled wrong? Have you ever felt a doctor was being intentionally cruel in a painful procedure?

Teaching Empathy (Fit Doctors and Sick Patients)

A reader asks:

My doctors are all very fit. It would seem that being a doctor is so demanding that it requires good health. Can doctors ever really understand what it's like to be ill?

Of course, doctors understand illness! We spend our whole lives studying it! ...but if you mean personal understanding of what it is like to feel your body betraying you, or the dread of approaching death, or the strained relationships created by severe illness—actually, most of us have never been there.

With a few notable exceptions, most people able to dedicate a dozen years of their prime to the punishing ordeal of becoming a doctor have always been pretty healthy in body and mind.

The worst Doctor D ever felt was a moderate case of sinusitis. I have no idea what how it feels to be in daily pain, to be unable to walk, to face death.

The Need For Empathy

So how do doctors, who are rarely sick, relate to ill patients?

Often poorly ...but if we do relate well it is through empathy: the emotional intelligence that allows us to experience the feelings of others. Doctors must learn the true experience of illness from our patients. Doctors may teach patients the science of disease, but in the experience of illness patients are the teachers and doctors are the learners.

Unfortunately, life in the medical business strains one's empathy. The sheer volume of suffering we see can make us numb. There is also the professional objectivity that we fear will be compromised if we care about your pain too much. Empathy may atrophy till a fit physician can diagnose and treat all day long without connecting with a single ill person in a humane, healing way.

Teaching Empathy

You—the patient—must teach the doctor. Empathy is a lesson physicians desperately need to learn. But how can you teach your MD?

The Direct Approach: Speak directly to your doctor about how uncomfortable your symptoms are and how miserable your illness makes your life. Remind your doctor about how horrible it is regularly, just to make sure they don't forget.

Hate to break it to you, but the direct approach doesn't work. In fact, it has the opposite effect. The more someone talks about their suffering the less we identify with it. Yes it's cruel, but it's human nature.

Remember when you were a kid and that elderly relative complained incessantly about their horrible bowels or joints? Chances are your grandmother really was miserable with those symptoms, but how much did you really empathize with her? Not much right? You just wanted her to stop complaining. It's called “compassion fatigue” and it has infected every doctor by about the 2nd year of medical school.

(By the way, I'm not saying you shouldn't tell your doctor your symptoms and how they affect you. Just don't expect compassion as the natural response to your discomfort.)

The Indirect Approach: Tell the doctors your symptoms and cooperate with them to diagnose and manage your disease. Only mention your miserable experience in passing. Instead, ask about how your physician is managing the stress of his or her life. Your doctor likely has a lot of frustrations despite their healthy body. Even if the doctor's problems seem petty compared with yours try to act like you care that it sucks to miss sleep or leave family dinner to care for a patient.

Believe it or not, this is the best way to teach empathy to doctors. The doctor will empathize with you instinctively.

We all naturally focus on our own sorrows and minimize the suffering of others. We awaken to empathy when we see that others care for us.

Doctors are educated in a system that only cares about how much they know and how hard they work. Few of their teachers care how they handle our rigorous training or the suffering they see. Doctors learn that feelings don't matter.

A caring patient's interest in a physician can teach more empathy than watching a whole world of suffering.

Doctor D has been told by patients that he is a caring physician. If so, it isn't because he has ever been ill himself, or any illness he's seen. It was because my first year of residency a patient with a miserable disease actually made an effort to find out about young D and encourage him. With an education like that how could I not want to understand the experience of every patient I met from then on?

What do you think? Is Doctor D too cynical about human nature? Have any patients out there had success with the “indirect approach” for teaching doctors to empathize? Healthcare people: Has a patient ever taught you empathy? Doctor D always loves to hear your thoughts and stories!