Do I Have To Love My Patients?

Many esteemed and very doctor-like doctors have spoken of how much they love practicing medicine.  They relish being a doctor, look forward to coming to work every day, and genuinely love each of their patients.  I like being a doctor.  And I’ve gotten good at it.  I’m unsure if I love it; I know I’d be pretty miserable doing anything else.  My coming into work doesn’t have a “running towards something I want” energy. It has a “running away from everything else” energy.  

That always makes me worry that I’m, if not really a “bad” doctor, at least an incomplete one.  Virtue ethics is a subset of clinical ethics that centers around what a physician of high moral character would do in caring for a patient.  I think a physician of high moral character does love her patients.  She not only wants to treat them because she gets paid to do so but because she feels an affinity for them that makes her want to help them live their best lives.  She’s kind, and kind people do things for people who are suffering.  She’s patient, and patient doctors do not get distracted by mental to-do lists while their patients discuss their chief complaints.  

Some physicians deliberately stop themselves from developing relationships with their patients because they think it makes things more challenging and puts them at risk for burnout.  In the ICU, we usually care for patients for a short time (precluding any deep relationship building) and sometimes for a long single admission or a period of frequent admissions.  It’s undoubtedly emotionally more complicated when a patient dies after we’ve had time to get to know them and their family.  Having a relationship with patients means there will be more than just medical care to talk about: other family members, what’s happening around town, “Why yes, I did get a haircut,” and comparing out-of-hospital-but-within-walking-distance coffee choices.  When bad things happen to people we care about, we feel bad; it makes less of an impact when they happen to people we don’t feel anything for in one way or another.  However, burned-out physicians are distanced from their patients.  One of The World Health Organization’s criteria for burnout is “increased mental distance from one’s job, or feeling negativism or cynicism related to one’s job.”  In medicine, this can look like depersonalization of patients, when physicians treat patients with indifference or objectify them by seeing them as a diagnosis rather than a person with a diagnosis.  So, by deliberately distancing myself from my patients, I’m practicing one of the defining features of burnout to avoid burnout.   That makes no sense.  

I’m starting to suspect that the distance we create between ourselves and our patients is one of the reasons we burn out.  Humans are social animals, and the cognitive dissonance of distancing ourselves from others takes a lot of energy.  Humans also have altruism genes that lead us to act in ways that reduce our individual fitness but promote the success of those who share those genes.  We are wired to interact and help each other.

But bad days happen.  We feel depleted, so we withdraw in the name of self-care.  But then maybe we don’t feel better in the way we expect to, so we withdraw more.  We still don’t feel good, so we build up more walls for self-protection that also inadvertently distances ourselves from all but the one or two people we’ve deemed “safe,” who don’t need anything from us, who won’t make us feel bad.  The worst-case scenario here is that we still feel awful; the best-case scenario is that we just feel numb.

What if I started to look for ways to love what I do?  Have you ever considered buying a particular type of car, and then suddenly, you see that car all over the place?  We can prompt our brains to look for what we want to find.  (The Sufi mystic and poet Rumi wrote, “What you seek is seeking you.”)  I can take advantage of my being a social animal, of my likely having at least some altruistic genes, and make my patients and their families the reason I love what I do.  For the patients and families I have long relationships with, I have already unconsciously identified something to like, or even to love, about them.  A conscious practice will allow me to find something to like or something to love with every patient and family I meet, no matter how brief the interaction is.  I invite you to do the same.  See how it changes your experience of practicing medicine, even if you only remember to do it once or twice daily.  In the words of Jason Isabell: 

I hope you find something to love

Something to do when you feel like giving up

A song to sing or tale to tell

Something to love, it’ll serve you well

     –Something to Love