The Cult of Medical Professionalism
Spoiler, I use the f-bomb to combat it
We’ve all had the experience.
You go in for a medical appointment or procedure to be greeted by a professional who bombards you with verbal diarrhea that they have already spouted 50 times that day and rushes you through the scanner like cattle. Or perhaps you have a sensitive issue to speak with your physician about, and while you’re trying to keep it together, they remain cold, stoic, and respond in obfuscatory jargon.
I hate it. And I am still sometimes guilty of this offense to my patients.
Your nurse or physician is not cold and heartless. They have been excessively indoctrinated in a culture of professionalism (and they are badly burnt out, which is a whole other story). From the day you walk in the door of nursing or medical school, you are programmed and expected to be formal and clinical. And if you’re like me, and just tend to be more authentic, you’re shamed for crossing boundaries.
Ok. Sure. I don’t want my health care provider to have a tattoo tear on their cheek or start flirting with me. I still have to ask you your birthday, but the drive to be professional prevents us from treating patients like human beings.
Part of the reason I wanted to practice on a remote island in the North Atlantic was that I find wearing this mask to be exhausting. I knew I couldn’t keep it up and I had hoped that practicing in a rural area might allow me to be more informal (and it does).
If the general population does not appreciate this comportment, vulnerable populations hate it with the fire of a thousand suns. If you want to make a patient with substance use issues or someone in poverty angry — be professional with them. People in this boat are de-humanized every day so when they’re emotional and you pretend to ignore this, they refuse to accept the feigned indifference. These sorts are my favourite people to treat. I don’t have to pretend to be respectable (I guess the cat’s out of the bag now!). We’re just two people having a real conversation — sometimes there’s jokes about beer or griping about everyday annoyances — but they almost always respond positively. And even if they came to me agitated, they’re less agitated when they leave.
I helped them.
I try to see my patients not as living bodies that I am trying to mend, but as human beings who only want me to be a human being. It’s hard though, when the medical system gives me only 10 hurried minutes with them, and most of that time, I’m doing a technical job. I’m thinking about the practical and technical things I have to do with them and the next person, and the next person, and the next person.
It requires presence. You have to be present with people. Sometimes it’s called Beginner’s mind.
I suppose I’ll tie this off with a story that exemplifies what I’m trying to get at:
I treat cancer patients. Most of them are constitutionally well, but we usually have a couple on treatment at any given time who are in hospital. Sometimes people come to us in a pain crisis. This is a clinical term — it doesn’t just mean that you’re in excruciating pain. It means that you’re in excruciating pain that can’t be controlled by opioid medication, or has spiralled so badly that you need to be admitted and observed to tailor medication enough to control it.
The patient in this story was in a pain crisis. She was young. She likely had young children, and although she wasn’t actively dying and all interventions stopped, she was moving in that direction.
Imagine being in your 30s or 40s, in adult diapers and a hospital gown, and being brought on a stretcher down for radiation treatment to control the pain from the tumor impinging on your spinal cord.
Imagine the worst pain you’ve ever had and multiply it.
Sometimes even transferring the patient on to the treatment bed is a production that requires four people, and takes ten minutes in and of itself. This was the case for her.
She’s screaming.
She’s crying.
She’s swearing.
She’s apologizing for swearing.
She’s in so much pain that the effort and energy to think about the answer to “What’s your birthday?” is too much, never mind trying to string together the words and say them.
After some shenanigans, we finally get her transferred over to the couch…It’s not a tempur-pedic, lemme tell you. It’s rock-hard carbon fibre.
Getting this far is more than she can bear and we haven’t even set her up or treated her. We’ve only got her on the bed. She breaks down in wracks of full body sobs of sorrow and anguish.
“I CAN’T. I CAN’T. I CAN’T FUCKIN TAKE IT!” she wails.
“I’M SORRY!” she confesses.
She’s in the worst kind of nightmare you can imagine (although you’d be surprised — it’s actually a bottomless pit that can go much deeper than this) and she’s apologizing.
My heart aches and breaks for her. There’s not much I can do about the situation. All I can do is let her know that I see her, and that I’m with her…But the usual platitudes are meaningless in this kind of scenario.
So I just said what I wanted to say to her.
I manage to catch her pained gaze, and stare her dead in the eyes. Very calmly, and very firmly, with no intonation in my voice, I tell her:
“It’s fucking horrible.”
“I’m sorry.”
I’m silent now, my eyes still locked on hers.
She grabs my hand and starts sobbing again.
A sincere and desperate “Thank you” eeks out between the bursts of sobbing.
Did I break the rules? Sure.
But it got through to her.
She knew I was being real with her, professionalism be damned.
I’m not suggesting we go around making rude and dirty jokes to patients. Nor would I wear a crop top and jogging pants to work.
I don’t teach this to the students. It has to be refined with experience, and by reading your audience.
But often I have my hands in my jean pockets when I’m talking to them about their side effects. If the whole day has gone off the rails and I feel like I’m on the floor of the New York Stock exchange at bell time, I might be hurrying them into the change room and frantically setting up the room when they walk in. But once they do, I’ll have an exasperated chuckle and sigh, and say “sorry — this day has been totally nuts”. I want to let them see that I’m having a bad day without resorting to autopilot and treating them like a car part on an assembly line.
I want them to see that I’m human too.
To be clear: This is anything but easy.
I’m torn between my empathy for the other health care folks who are just trying to get by, and my ability to relate to being a patient. I’m still guilty of giving in sometimes. But I work very hard to bring my attention back to the patient, because in spite of burnout and the cult of medical professionalism, I really do care.
For further exploration, check out CBC Ideas episode “Healing and the Healer”
This story was inspired by Amethyst Champagne’s post The Art of Swearing.
