Our attitudes towards patients

The lecturer was trying to make a point: “The hand that writes the opiate writes the laxative. You may not think that constipation is such a big deal, but wait until you're on the wards next year guess who gets to do the digital disimpactions?” He left the podium amid laughter and groans. No one wanted to be the clerk stuck with that task.

The next lecturer was a nurse: “It's 10 times worse for the patient. I don't think you realise how painful and humiliating it is for a patient to have to go through something like that.”

Most of our lecturers are doctors with multiple graduate degrees and illustrious publications. They teach us the basic science and clinical reasoning behind medicine, but they also teach us another, more subtle, lesson with their language and behaviour. They crack jokes at a patient's expense that are often appreciated in an otherwise dull lecture; they roll their eyes as they turf patients for a psychiatric consultation; and they recommend Samuel Shem's The House of God as a fundamental part of our medical education.1 I have read the book, hence my use of “turf,” but I understand that this is written from the medical professional's perspective.

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Although I understand why the nurse made her comment, I also believe that these comments will only serve to further divide medical students, our future doctors, from their patients. The doctor's joke, our subsequent response, and the nurse's reprimand only serves to create an “us and them” mentality. We laugh because we do not associate ourselves with the patients whom we serve. The nurse, by rebuking us, identifies herself with “them” and may be isolating herself from us, the medical students, inadvertently. Similarly, lectures and seminars devoted entirely to the topic of “being nice” may prove of little use. The amount of eye rolling that goes on during these talks is inversely proportional to the number of people taking notes or even paying attention.

I think there is a problem with how medical students perceive patients' care, and that problem cannot be tackled adequately with more lecture time or exam questions. If you want medical students to understand what it is like to be a patient, why not just let us talk to patients and learn from their experiences first hand? The softer lessons in medicine (empathy) are better acquired through subtler means. In the same way in which we internalise jaded messages about patients, we can also learn how best to treat patients as worthy human beings, by witnessing our preceptors offer a kind word or a pat on the back. I have seen many doctors treat patients with the same respect and dignity that they afford other doctors. My emotional development as a medical student can be attributed largely to my encounters with these wonderful physicians, rather than the lists that they want us to memorise in class.