People, people who need people,
Are the luckiest people in the world
We’re children, needing other children
And yet letting a grown-up pride
Hide all the need inside
Acting more like children than children.
“People” is a song composed by Jule Styne with lyrics by Bob Merrill for the 1964 Broadway musical Funny Girl starring Barbra Streisand, who introduced the song.
My newly minted son-in-law just started his internship and residency in emergency medicine in Denver, Colorado this summer. I feel for him. The first year is designed to be hell, and it usually is. Once you’re past it, things get better and better in many ways. But first, you have to learn. A lot. You think you absorbed so much in medical school and that you are now a doctor because you have MD after your name. Wrong. You are just starting your journey to being not just a doctor, but a physician.
It starts early, the indoctrination. Living, breathing people who come into your circle of influence, no matter how small it is as an intern, are sick. They’re hurting. They’re wanting something from you. They may be at risk of dying. Your job is to rapidly assess what you see in front of you, make a diagnosis, and fix it. Simple, right?
You learn to run with the numbers, the trends, the evidence base. You know how many symptoms of what severity need to be present to diagnose an acute myocardial infarction or an abdominal ileus or a suicidal depression. You listen, you examine, you rapidly run through a differential, you get labs and studies to augment your thinking, and you decide what to do.
You fix it.
If you’re a psychiatrist, you might do this fifteen times a day. A family doctor might do this fifty times in an afternoon. An ED doc might do it a hundred times in a shift in a busy ED.
The powers that be in medicine these days are trying to turn us all into fast-talking, fast-typing, money-making medical technicians. We evaluate, crunch the numbers and act. Next. Repeat.
Sick people have become patients have become clients have become consumers of medical services have become members have become souls.
We doctors are fast losing touch with what makes us who were are. Healers.
I am learning more about the practice of psychiatry and about myself now than I have ever learned before. I don’t like all of it, but I’m embracing it. As I get older and continue to practice medicine, I learn important things on a more and more regular basis.
One of these is a very simple, back to the basics kind of discovery.
My patients are still people.
In some of my practice settings, I have begun to see the third and even fourth generations of patients from the same family come to me for help. These multiple generations are teaching me about the heritability of depression, bipolar disorder, schizophrenia and substance abuse. They are teaching me about the realities of dysfunctional family dynamics and domestic violence. I hear their stories and I listen. I learn.
I have found that appointments have become visits. Visits have become real conversations. Both patient and doctor look forward to these. This is why I chose psychiatry as my primary specialty all those years ago. I do not want to be the six minute prescription pusher who knows little to nothing about the life of the person he is treating. I can’t practice medicine that way. Never have. Never will.
I look forward to seeing my patients and hearing what they have to say.
I have recently returned to cover a clinic where I have not seen patients for the last seven years. I have changed. Some of my former patients have not. I am seeing many more children than I have ever seen. That may be another post for another day. The return to that clinic, especially following a beloved physician who retired and who practiced similarly but not exactly like I do, has been a lesson in humility, resilience and improvisation.
In the end, the bottom line is that I went into medicine to help people, like many doctors did.
I decided to be a physician because I wanted to get to know people on a level that is almost impossible in any other job or setting. I feel extremely blessed and lucky to be able to do what I do. I am grateful for the chance to reach out, engage, and help.
I’ve told you before that I’m an introvert at the core of it (some of you still don’t believe that), but even introverts need social contact, one-on-one time, relationship.
People who need people are the luckiest people in the world.