Post by medic09 on Jul 12, 2011 8:39:49 GMT -5
I recently commented in a discussion among mostly rabbanim about the need for better human qualities in medical care, starting with interviews and education/school. My comments below. Like all mussar, this ought to be our daily commitment, no?
Rav X,
This is indeed a critical area needing improvement; and one that is revisited from time to time around the world with little lasting change. I think it is appropriate that treating every patient as bearing tzelem Elokim (respect) and as kin (love) be promoted by community rabbanim. Patients are an especially vulnerable group, and therefore prone to heightened experiences of anxiety, pain, etc. Medical providers of all levels and stages - EMS, ED staff, inpatient staff, outpatient staff and family physicians - need to be acutely aware of this; and sympathetic to it.
I try in some way to treat my patients this way, and due to avonotai harabbim, I succeed inconsistently. A few brief thoughts on this.
1. One issue is simply a lack of insight. An example is how we treat homeless patients. Dirty, smelly, sometimes unpleasant individuals come to the ER; and of course the staff aren't thrilled to deal with them. Maybe since I am a (Tzahal) veteran I sympathize more, knowing how many of these people are veterans who are paying a permanent price for serving civil society. Many start unknowingly self-medicating for anxiety and PTSD with drugs and alcohol, and soon find themselves broken addicts. Alternatively, many homeless people are mentally ill. After discussing this with some of our techs in the ER, and modeling how these people might be better treated, I see a real improvement in some attitudes. But it needs constant reinforcement.
2. I have often said, only partially in jest, that direct care providers should be at least 30 years old and have lived a bit. In the American system one becomes a doctor or nurse by going straight from HS to college to med school to residency. What do these kids understand about their patients' lives? What do they know about babies or old people? When did they have a chance to develop real-world adult insight, social skills, or common sense?
3. Time and money. I recently returned to ER work after a year-long hiatus for injuries. A young couple (wife suffering chronic intractable mysterious pain) told me how grateful they were I had stepped in to replace the first nurse who worked with them. Even though the wife continued to suffer, they appreciated my attitude and attention and said it really transformed their suffering. Colleagues commented that patients were positively affected by me. But I was told I spend too much time with each patient. We have to keep bodies moving through the ER. It is inefficient and costly to spend time listening, talking, just relating. We don't get paid for that. Back when my wife ran her own practice, she figured she spent between 2 and 4 times as much time with each patient as the insurance companies actually paid for. That means earning far less. And every kupat holim doctor can certainly tell a similar story.
4. Let's face it. Some people just aren't as nice as others. Eventually, that will be across the board. So, if a doctor is too curt or worse with the patients, he probably isn't much better with the nurses and techs. Not for long, in any case. I had one physician tell me, 'I'm just not as nice as you' after I argued for a little more time and care for a patient.
4a. A corollary is that some folks are just way more cerebral and less personal. My father's physician graduated high in his Harvard class. But he was a technocrat. He ordered lots of tests, but hardly touched the patient. Eventually that leads (and did in my father's case) to bad medicine. Providers have to get close to and personal with a patient to discern what may really be happening with them. But some providers, especially higher levels like physicians and specialists, are drawn to their profession for the intellectual challenges rather than the personal contact and care. So, they can be more distant and cold when relating (or not) to the patient.
5. It is easy to teach quantifiable things like competencies. Kindness is something that we really have to believe in, and have to buy into. I believe and advocate that after immediate safety, kindness is our first task. That is not how we teach physicians and nurses. A well known EMS educator out here teaches his crews to remember that patients are often having the worse day of their lives when they call us. Or they think so, anyway.
5a. Large programs always deal better with measurable qualities. Grades. Outcomes. Numbers. It doesn't matter if it is an elementary school or med school (or rabbinical school). When teaching 30 or 50 or 100 students it is much easier to measure them up by their grades than individual qualities. So, even after careful selection of candidates, we still end up with a far greater emphasis on masses of information (essential), on grades and skills. Personal instruction and promotion of personal qualities would require much more personal education. Too expensive and inefficient. Patient care is little different. I have never been asked if I was especially kind to anyone today. I, and the physicians, are asked to see a certain number of patients in a certain amount of time and space.
We have to contend with this every day, in every stage of our education and practice. We have to be determined that it not effect us personally, or dictate how we treat patients. We also have to be determined to have a personal positive impact, instead. Sur m'ra v'aseh tov. In the end, who we are and what we really believe remains the foundation of our patient care practice. See again my #2 above. Personal depth, mussar, and strength need to be founded before school, and forever more reinforced. When young soldiers go to Tzahal, the yeshivot hesder stay in touch, constantly supporting them. The questions of halacha and mussar are continually addressed before, during, and after their service. But it is no secret that many of the soldiers around them behave more badly. Why would we expect any different anywhere else in society?
Mordechai Y. Scher
NREMT-P, FP-C, RN
Emergency Dept., C/SVRMC, Santa Fe, NM, USA
Western States Air Medical, Las Vegas, NM, USA
Beit Midrash Kol BeRamah
www.kolberamah.org
Rav X,
This is indeed a critical area needing improvement; and one that is revisited from time to time around the world with little lasting change. I think it is appropriate that treating every patient as bearing tzelem Elokim (respect) and as kin (love) be promoted by community rabbanim. Patients are an especially vulnerable group, and therefore prone to heightened experiences of anxiety, pain, etc. Medical providers of all levels and stages - EMS, ED staff, inpatient staff, outpatient staff and family physicians - need to be acutely aware of this; and sympathetic to it.
I try in some way to treat my patients this way, and due to avonotai harabbim, I succeed inconsistently. A few brief thoughts on this.
1. One issue is simply a lack of insight. An example is how we treat homeless patients. Dirty, smelly, sometimes unpleasant individuals come to the ER; and of course the staff aren't thrilled to deal with them. Maybe since I am a (Tzahal) veteran I sympathize more, knowing how many of these people are veterans who are paying a permanent price for serving civil society. Many start unknowingly self-medicating for anxiety and PTSD with drugs and alcohol, and soon find themselves broken addicts. Alternatively, many homeless people are mentally ill. After discussing this with some of our techs in the ER, and modeling how these people might be better treated, I see a real improvement in some attitudes. But it needs constant reinforcement.
2. I have often said, only partially in jest, that direct care providers should be at least 30 years old and have lived a bit. In the American system one becomes a doctor or nurse by going straight from HS to college to med school to residency. What do these kids understand about their patients' lives? What do they know about babies or old people? When did they have a chance to develop real-world adult insight, social skills, or common sense?
3. Time and money. I recently returned to ER work after a year-long hiatus for injuries. A young couple (wife suffering chronic intractable mysterious pain) told me how grateful they were I had stepped in to replace the first nurse who worked with them. Even though the wife continued to suffer, they appreciated my attitude and attention and said it really transformed their suffering. Colleagues commented that patients were positively affected by me. But I was told I spend too much time with each patient. We have to keep bodies moving through the ER. It is inefficient and costly to spend time listening, talking, just relating. We don't get paid for that. Back when my wife ran her own practice, she figured she spent between 2 and 4 times as much time with each patient as the insurance companies actually paid for. That means earning far less. And every kupat holim doctor can certainly tell a similar story.
4. Let's face it. Some people just aren't as nice as others. Eventually, that will be across the board. So, if a doctor is too curt or worse with the patients, he probably isn't much better with the nurses and techs. Not for long, in any case. I had one physician tell me, 'I'm just not as nice as you' after I argued for a little more time and care for a patient.
4a. A corollary is that some folks are just way more cerebral and less personal. My father's physician graduated high in his Harvard class. But he was a technocrat. He ordered lots of tests, but hardly touched the patient. Eventually that leads (and did in my father's case) to bad medicine. Providers have to get close to and personal with a patient to discern what may really be happening with them. But some providers, especially higher levels like physicians and specialists, are drawn to their profession for the intellectual challenges rather than the personal contact and care. So, they can be more distant and cold when relating (or not) to the patient.
5. It is easy to teach quantifiable things like competencies. Kindness is something that we really have to believe in, and have to buy into. I believe and advocate that after immediate safety, kindness is our first task. That is not how we teach physicians and nurses. A well known EMS educator out here teaches his crews to remember that patients are often having the worse day of their lives when they call us. Or they think so, anyway.
5a. Large programs always deal better with measurable qualities. Grades. Outcomes. Numbers. It doesn't matter if it is an elementary school or med school (or rabbinical school). When teaching 30 or 50 or 100 students it is much easier to measure them up by their grades than individual qualities. So, even after careful selection of candidates, we still end up with a far greater emphasis on masses of information (essential), on grades and skills. Personal instruction and promotion of personal qualities would require much more personal education. Too expensive and inefficient. Patient care is little different. I have never been asked if I was especially kind to anyone today. I, and the physicians, are asked to see a certain number of patients in a certain amount of time and space.
We have to contend with this every day, in every stage of our education and practice. We have to be determined that it not effect us personally, or dictate how we treat patients. We also have to be determined to have a personal positive impact, instead. Sur m'ra v'aseh tov. In the end, who we are and what we really believe remains the foundation of our patient care practice. See again my #2 above. Personal depth, mussar, and strength need to be founded before school, and forever more reinforced. When young soldiers go to Tzahal, the yeshivot hesder stay in touch, constantly supporting them. The questions of halacha and mussar are continually addressed before, during, and after their service. But it is no secret that many of the soldiers around them behave more badly. Why would we expect any different anywhere else in society?
Mordechai Y. Scher
NREMT-P, FP-C, RN
Emergency Dept., C/SVRMC, Santa Fe, NM, USA
Western States Air Medical, Las Vegas, NM, USA
Beit Midrash Kol BeRamah
www.kolberamah.org