A story in the Jamaican Sunday Gleaner (May 24, 2015) entitled “Multimillions in medical mistakes” described a number of pain and suffering endured by patients due to apparent medical negligence. The cases reported were the ones in which patients had taken legal action. I hear similar tales from my patients : tales of the physical, emotional and financial distress that they have endured at the hands of other doctors they have visited. In many cases, much of that suffering could have been avoided if the basic principles of taking a good history, and doing a thorough physical examination had been followed. These are principles that are drilled into us as medical students at the University of the West Indies. It is perhaps one of the reasons UWI trained doctors are recognised for their clinical acumen in countries like the USA and Canada. In spite of this excellent clinical training, our patients are still suffering. We need to ask why this is happening in a profession that has as its core mandate to do no harm.
I think the answer lies in appreciating the importance of being compassionate in the practice of good medicine. Compassion is the quality that makes us treat other human beings the way we would want to be treated. It is the trait that makes a doctor listen carefully, speak kindly, and touch gently. Compassion is the thing that makes you realise, from the address in the docket, that the patient in front of you in a busy clinic has travelled a long distance, probably on public transport, and sat for hours on a hard chair, for the chance to have their health complaint addressed. Compassion is the thing that makes you give that patient your full undivided attention (without distraction of cell phone etc.), even if it is only 5 minutes, because there are so many patients to see. Compassion is what makes it possible to hold the hand of dying patient, when there is nothing else you can do for them; to stroke the brow of a child in pain; to give an elderly man the chance to vent his sadness that the children he raised have left him alone in his old age; to provide an opportunity for a patient’s to express grief over loss of a loved one. In short, it is love and consideration for one’s fellow human beings.
All the clinical expertise and theoretical knowledge in the world cannot substitute for compassion when dealing with human beings in pain or discomfort. Doctors need to understand that the task is to use your training with compassion to help fellow human beings feel better, not just to diagnose and cure disease. Recognising the importance of being compassionate in the practice of medicine is even more critical in these times when many of the diseases affecting people are incurable.
Twenty five years ago, when I applied to the Faculty of Medical Sciences at the University of the West Indies, the only admission requirement was an academic one. The current requirements include a maximum 300 word “sketch outlining reason for career choice” and “evidence of involvement in relevant extra-curricular activities, socially oriented projects and voluntary community service in the year prior to your application.” So, although the selection criteria has shifted to at least acknowledge the importance requirements other than just academic prowess, I really do not think that looking for evidence of compassion in only the “ year prior to your application” will ensure that the candidates selected to be trained as doctors will also be people with an abundance of compassion. Both academic achievement, and on-going life-long evidence of being a kind considerate person should be at least equally important.
Neither intelligence nor compassion can be taught at university, but being above average in both traits are, I think, important to do well in medicine, especially if “doing well” is measured by patient satisfaction. It is widely accepted that one has to be “bright” in order to do medicine. It is indeed very useful to have a shade above average intelligence in order to systematically acquire and store (in a retrievable fashion) in one’s brain, all the facts, figures and concepts needed to know how to care for patients. Less widely appreciated is the fact that making patients feel better should be the goal of every doctor . In order to achieve that goal one must have compassion, and, to achieve that day after day, under very trying circumstances (such as our public health system), the level of compassion needs to be above average.
If we select our medical students with a heavy bias towards academic prowess, and a only token gesture towards the demonstration of compassion we fail to acknowledge that the care of human beings is the very essence of this profession. Effective delivery of such care requires engaging both brain and heart equally. In the words of Kahlil Gibran, for those who want to pursue a career in this noble profession: “Work is love made visible. And if you cannot work with love but only with distaste, it is better that you should leave your work…”