Of medical sense and sensitivity

Tears streamed slowly down her cheeks as she unsuccessfully tried to endure the blinding pain in silence. She was in her 60s and had come to the hospital for free treatment from a small distant village, by bus with no one to help her.

The professor demonstrated the clinical examination of a tender, diseased part of her anatomy. Each of my friends then practised examining her. More demonstrations and more practice elicited more painful cries.

She did receive compensation - some free drugs and more time to talk (long enough to clear her doubts) with the doctor. The latter is a rare privilege for patients such as her who come in their thousands to hospitals offering free or minimally charged care.

I chose medicine hoping to acquire the skills to alleviate pain. Job satisfaction was also a strong influence.

As freshers, not having witnessed the dissection of a frog before, many of us felt a degree of disturbance. Two years later, the same people were practising examining a distressed patient and exacerbating her pain. I expressed my thoughts and was told that it was the only means to learn the art of medical examination. The alternatives, such as using models, seemed to have eluded consideration.

I discovered with sadness that, as a student of medicine, I was highly prone to insensitivity. Maybe I'd already contracted it. But the volte-face in my counterparts was shocking. There are instances of students eliciting abnormal mobility in non-union fractures, practising lumbar puncture or intramuscular injection on patients without proper supervision or knowledge of the correct procedure - sometimes, solely for needs of practice.

Any pain unnecessarily induced in a patient in a clinical assessment exam, such as the United States medical licensing exam (USMLE) or the Professional and Linguistic Assessment Board's test (PLAB) would yield an F equivalent. Among the many tips I've heard is the necessity to be ethical, in compliance with Western standards, to pass a test. It is unfortunate that what has to spring naturally out of human existence and more so after five and a half years of medical education is taught as a requirement for passing examinations.

Doctors need to be indifferent as professionals to avoid misjudgment or mistakes arising from emotional involvement. Reassurance and good care of patients, however, are inarguably important qualities of a good clinician.

How then do medical professionals become inured to human suffering and pain? Perhaps it is the constant exposure to physical and mental suffering that creates the passivity. Or worse, maybe, it is indifference to a fault, which projects patients as biological machines rather than human beings.

The old lady thanked the doctor and left. She had a long journey ahead. So does certain aspects of clinical medicine.

Competing interests: None declared.

Sowmya Sivaranjini, A Pratapan third year medical student, Madras Medical College, Chennai, India
Email: ap.sowmya@gmail.com


studentBMJ 2006;14:309-352 September ISSN 0966-6494

       

           

	REVIEWS Of medical sense and sensitivity       Sowmya Sivaranjini (September 2006)
	Dr Avinash Aujayeb (August 28th, 2006)       F2, North Tyneside General Hospital avinash.aujayeb@ncl.ac.uk
	It is widely believed that we are uncaring and insensitive.However, we need a certain degree of insensitivity to cope with our daily ritual of breaking bad news to absolutely wonderful and loved members of the general public.We would be on a path to self-destruction if we were to not emotionally distance ourselves from a patient we have known for ages and diagnosing him with a terminal disease.Or not wanting to cause pain to a patient might entail us missing an important diagnosis. However, in some instances,the above criticism of doctors is not unfair. I have encountered some doctors whose practice are appalling but i do think they were behaving as such because noone had to them otherwise.A yearly,random assesment should be present,even for the consultants,to ascertain they display a certain amount of compassion. All medical care givers should seek a balance between themselves on the foregoing,all the time thinking 'primum non nocere' ("first of all do no harm")