Heroes Not Zombies

My daily working life is that of a doctor. That only tells you a little because Medicine is a very broad subject and doctoring can require extremely different sets of skills. Sometimes I muse about just what is the job of a doctor? Or what makes for a good doctor? I’m pretty sure it involves trying to understand people better. I’m also pretty sure it involves helping people. It involves never thinking you know everything or that you are definitely right! (I know that’s a surprising conclusion but there’s a difference between being decisive and being certain…..read the linked post for more on this). I think it’s also a common experience that a good doctor is one who gives a damn ie one who cares. However, the specifics of the working life of a doctor depend a lot on the context of the doctor’s work. I made myself a “human spectrometer” to clarify this point.

Most health care is created around systems. There are whole departments defined on the basis of their focus on a system – Neurology, Urology, Gastroenterology etc. The focus of a doctor in that department is a particular system of the body. He or she becomes expert in the diseases and disorders of that system and acquires the knowledge, tools and experience to intervene, to either resolve, or to manage those disorders. Some doctors specialise more than this. Move left a little from the system on the spectrometer. We have both medical and surgical specialists who focus on one particular organ, or part of a system, like liver specialists, hand surgeons, and so on, and following that path further left we have biochemists and geneticists who concentrate on the functions right down at cellular, or intracellular levels. Jumping to the other end of the scale, there are the epidemiologists and the Public Health doctors who consider disease at a population level. I’m a great admirer of the work of Prof Richard Wilkinson who makes clearer than anyone else I know just what an impact inequality has on population health. The knowledge, skills and experience he needs to do his job are quite different from those of the hand surgeon. Move left again along the spectrum from the right hand side. There are doctors who focus on families, whose everyday lives involves working with whole families, or parts of families. Then there’s me. Right there in the middle. There are lots and lots of doctors like me. Our days are spent largely in consulting rooms with individual patients. Our approach is a generalist one, not a specialist one. We focus on the person. The skills, knowledge and experience needed to do this kind of daily work is holistic, narrative-based and focused on the ability to listen, to communicate and to understand at an individual level.

So each doctor needs the skills and the knowledge appropriate to their practice but there’s something else all doctors share. We are all trying to relieve suffering.

Suffering isn’t a word you’ll find in medical textbooks (just like you won’t find the words “health” or “healing” in textbooks of clinical medicine either!) but it’s our raison d’etre. You can judge me by it. I judge myself by it. When I go to work any day, I want to relieve suffering. If I interact with a patient and don’t feel that I’ve contributed to a relief of their suffering by my involvement and my actions then I don’t feel I’ve done my job. Dr Eric Cassell’s book, “The Nature of Suffering”, deals with this issue beautifully. He says in this book, and in his others, that he changed his clinical practice by deciding to focus on the issue of the patient’s suffering. In fact he explicitly asks his patients to tell him about their suffering as a powerful way of allowing them to set and declare their agenda and for him to focus his care where it matters. In that book he shows how suffering might lie in an individual patient, but it might lie in their relationships, their family, their workplace or community. You could, in fact, ask that question at any point on the “human spectrometer” above. Just where on the spectrum does the suffering lie?

However, human beings have a complex relationship with suffering. It might even be extolled as something good – “No pain. No gain” “I have to suffer for my art” I’ve read more than one book which considers the place of a serious illness in an artist’s life and puts forward the hypothesis that it was their suffering which enabled them to produce their distinctive, great art. I recently read David Lynch’s book, “Catching the Big Fish; Meditation, Consciousness and Creativity” (which I highly recommend actually!) where he powerfully refutes that argument, claiming that Van Gogh might have had the chance to produce even more and even greater art if he hadn’t had all that suffering to cope with in his life. Suffering gets a good press in many religious teachings as well as in a certain kind of New Age thinking. There are many spiritual practices based on inflicting suffering on the body and there’s even a belief in destiny, or Fate, or karma, which states that if you are suffering it’s because that’s what your soul requires. Even the “quest story” of Arthur Franks, as exemplified in Lance Armstrong’s “It’s not about the Bike” shows how suffering can be a path to growth and development.

I’m not denying any truths which lie in those beliefs. Nor am I claiming to know better. But let me be very clear, as far as I know, nobody, given the choice between a path of suffering and one of bliss, chooses suffering. We only choose suffering if we can see no other way to get to where we want to be. If we can find another way that doesn’t involve suffering we’ll choose it. So, yes, maybe my job involves helping people to make the most of their suffering, or to even get something good out of it, but, my first priority, my prime motivation is to do my best to relieve it.

Whether I can help relieve someone’s suffering or not, the inextricably related goal I have is to help that person to have a good life. The point of relieving suffering is to enable a person to experience a good life. But as suffering is an inevitable thread that winds its way through all lives, a doctor’s job is to help people to have a good life, whether they are suffering or not.

Doctors are not the only people to help others to lead good lives of course, but I do think a doctor who loses sight of this goal, loses sight of what it is to be a doctor.

PS Now you’ll be thinking “ah, but what is a GOOD LIFE?” Me too! (I’m working on a post about this but here’s an earlier one to be going on with)