Navigating the Emotional Journey of Medicine

Students in our Charter class are well into their second semester after a much-deserved break over the holidays. There has been much said about the integrated curriculum at USC School of Medicine Greenville, beginning with clinical training as Emergency Medical Technicians (EMT) and imbedded into the largest hospital system in South Carolina. The curriculum provides interactive self-directed educational experiences from “classroom to bedside” that are designed to foster and enhance the progressive acquisition of essential medical knowledge and clinical skills.

I think it is fair to say that our students have not experienced the frustration felt by many in a more traditional curriculum in which long hours in a classroom setting are often devoid of clinical relevance and patient contact until the third year of medical school. However, the opportunity to immediately interact with patients quickly brings to light the reality of not only the joys of medicine, but the sorrows, challenges, and sometimes profoundly tragic events that forever impact not only the patient and family, but also the provider. During EMT shifts, in speaking with cancer survivors and parents of special needs children, and in interviewing hospitalized patients kind enough to consent to being examined, our students have quickly learned that patients and their circumstances often have a profound emotional impact.

Although my career—now close to 30 years—has been filled with numerous memorable patients who, through their perseverance, determination and faith, have recovered from severe illness or trauma, I have had my share of equally (and perhaps more) memorable heartrending outcomes. One student recently shared his experience in participating in an unsuccessful effort to resuscitate a two-month-old child. The impact of this event was understandably one of sorrow, anger and confusion. It is times like these when all providers must, in an interdisciplinary fashion, support, encourage and listen to one another.

We must also encourage one another (and practice what we preach) to find appropriate outlets to address stress, be it exercise, reading, journaling, spending time with loved-ones, etc. It is unwise to steer clear of (purposely or not) sharing our thoughts, struggles, and vulnerabilities which invariably occur following a poor patient outcome. Not only is it unhealthy to avoid what I might call, for lack of a better term, “the health care provider grieving process,” it places us at grave risk of becoming less compassionate, less understanding, and less empathetic towards our future patients. Unfortunately we will always have patients who desperately need to be well aware of our compassion and concern; yes, there is the necessity not to get “too close” or “too emotionally involved” with our patients, but there is also a real danger of becoming too emotionally detached, which in my mind is tragic.

As hard as each student works, be it in the classroom, a small group, an EMT shift or late night studying, I am reminded of the importance of balance in our lives; a difficult patient or tragic outcome must not cause any of us, students and faculty alike, to withdraw in order to study and work “24/7,” perhaps in a vain attempt to falsely assure ourselves that if we just knew more and worked harder that our patients will always have a good outcome. One of our students recently wrote wondering if this “physician thing” would, in the end, “be worth it,” to which I respond, with utmost confidence, that it will indeed, but only if the definition of “worth” is all inclusive and not just defined by the status of your residency program, a certain number of publications or awards that might cover your walls.

The journey to becoming—and in being—a physician is daunting and must be taken in a step-wise fashion, regardless of one’s position on the continuum between medical school and eventual retirement. Efficient and effective study time is, in large part, dependent upon quality personal time. Easier said than done? Absolutely… but it is a good habit to develop early in your career. It requires extraordinary time management skills, a commitment to your education, an impeccable work ethic, and yes, loss of a great deal personal time; but it also requires replacing a “super-physician” mindset with a balanced commitment (balanced over the long run, often not over the short run) to career, family and outside interests.

None of us will ever know all that we need to know, but we have the technology available to immediately obtain the information we require. We must also have the self-confidence, humility and courage to ask for help from others and to work in an interdisciplinary fashion to provide health care to our patients, while remaining healthy ourselves. It is indeed a privilege to be a part of our students’ journey, which in the end, will indeed be well “worth it,” for there is no greater privilege to serve others through medicine.

Dr. Paul Catalana is the Assistant Dean of Admissions and Associate Professor of Clinical Pediatrics at the USC School of Medicine Greenville.