Student soapbox: descent into cynicism
Rob Morris cannot understand what's happened to his good intentions
So it's finally happened. I've been a clinical student for three months, and that spark of idealism and compassion that compelled me to enter "medicine" on my application form for university four years ago has been well and truly quenched.
I realised this as I sat in a local pub with the newest member of my tutorial group. A teenager, fresh from A levels, complete with made to measure trousers, she unwittingly revealed that she wanted to be a doctor so she could "help" people. I exchanged a weary, knowing glance with the final year student in the group and was suddenly transported back to my own interview at medical school. The dean had exchanged the same glance with the senior lecturer when I had confessed breathlessly that I wanted to "save lives."
I had been so sincere all those years ago, but that was before I'd had any experience of hospital medicine, chronic illness, and the sheer tedium of getting a history from a patient with chronic obstructive airways disease who was also deaf. My compassion, which I had nurtured so successfully through the preclinical years, began to wane.
The final straw came this week, completing my transformation from would-be do-gooder to hardened cynic. Coming to the end of my gastrointestinal attachment, I had to fulfil the course requirements by handing in histories of 10 gastrointestinal conditions from the list of 15 in my log book. The first six were easy: jaundice, colorectal carcinoma, gall stones, hernias, ulcerative colitis, and Crohn's disease.
I seemed to trip over these conditions every time I stepped onto a ward. But where was I going to find a patient with achalasia? And why didn't appendicitis ever come in when I was on call? I was no longer viewing patients as "individuals with illness." They had become walking (or preferably supine) pathologies, and annoyingly, they weren't even the right pathologies.
Worse was to come. I kept my fingers crossed as I clerked an emergency admission who had "?acute upper GI haemorrhage" written at the top of his notes. The reason for crossing my fingers wasn't because I hoped he'd get better soon and resume his previous quality of life. Oh no. I was praying he'd have a perforated peptic ulcer, so I could tick another box in my log book. When nothing showed up on his endoscopy I began to worry, and when he was discharged a few days later I was furious that he'd had the temerity to get better without developing a single tickable pathology. He was of absolutely no use to me at all. Do these people think we're just clerking them in for fun? I have now managed to get my 10 cases, but it's certainly no thanks to the disappointingly good health of the people of Sheffield. Being a medical student, I began to realise, has nothing to do with making people "better." The exact opposite is closer to the truth. A patient with chronic alcoholic liver disease, jaundice, ascites, and a hernia is like manna from heaven. Only rarer, unfortunately.
The descent of my soul continues. I look forward to becoming a fully fledged Satanist by the time I qualify, and no doubt I shall be the Prince of Darkness's right hand man if I ever become a consultant. I wasn't surprised when my senior house officer gave my junior house officer a nasty compound fracture of the right tibia last weekend. He claims it happened in a moment of drunken "sport," but I suspect that really he needed an extra case to finish a tricky orthopaedic assignment.
My tutor in health and society might describe my development as a shift from the functionalist perspective, as my original thinking was that patients want to be cured and staff wish to cure them. I suppose this shift is towards a more political economist stance, considering the doctor-patient relationship to be characterised by a conflict of interests between the doctor and the patient.1 Whatever, I'm just glad I got my homework done on time.
Rob Morris fifth year medical student, University of Sheffield
studentBMJ 2000;08:175-216 June ISSN 0966-6494
- Scambler G, ed. Sociology as applied to medicine. 4th ed. London: WB Saunders, 1997.
