Thursday, August 28, 2008

On the Razor's Edge

As I go through my medicine sub internship, I am struck by how little of what I do during the day actually relates to medicine. I’d say I spend approximately 60% of my day doing paperwork, 30% doing social work, and perhaps 10% actually practicing medicine. If you ignore the paperwork, the relative ratio implies that I spend three times as much time dealing with social issues relative to medical issues. Perhaps this issue is unique to this particular rotation in this particular hospital, but I often feel that it is endemic throughout my rotations, especially in primary care specialties.

For me and many of my peers, I think much of the frustration within medicine stems from this skewed ratio. We have not spent all these years training to deal with people's social concerns. Don't get me wrong, I am not belittling the importance of these problems in our patients' lives. My point rather is that, just as social workers are not trained to titrate blood pressure control medications, physicians are not trained to deal with the myriad of social issues our patients face. That is not our role in the system. Of course, in a case of need, physicians should do everything possible to help their patients, but using physicians as social workers is an inefficient use of their time. Furthermore, because they cannot dedicate their time fully to social issues, physicians let such items lapse, which in the end does not serve the patients' interests.

For me, medicine is interesting when I feel that I can take the knowledge I have learned and apply it to a patient in an uncertain situation. As cliche as it seems, I want to know that my actions made a difference, and I imagine most of my peers feel the same way. For the patient who enters our care on the razor's edge, teetering between calamity and convalescence, I want to know that my actions helped pull the patient through the darkest of times and that my training was not in vain. Is it selfish to feel this way? Perhaps, but I would rather be a selfish but satisfied physician than one who begrudges my patients' concerns and in the end does not serve the patient at all.

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