Medice Cura Te Ipsum

Today I attended a really interesting talk by sociologist Dr Jonathan Imber and his good friend Dr Lorenzo Berra, a professor of Anaesthesia at Harvard medical school. The talk was titled 'medice cura te ipsum', a latin phrase taken from the bible which is best translated as 'Physician, Heal thyself'. The phrase is best understood as 'counsel to your defects before you counsel the defects of others', an important message in complicated field of medicine.  

Jonathan Imber specializes in the sociology of medicine and its historical and religious dimensions, while Dr Berra works in the intensive care unit at Massachusetts general hospital. Imber published in 2008 the book Trusting Doctors: the decline of moral authority in american medicine, a topic I'm sure many doctors particularly older ones can relate to. 

The talk started as simple discussion about the origins of their friendship, in the shadowing experience of Imber's son who had some doubts about pursing a career in medicine. Dr Imber went on to highlight the importance of experience with people being a key factor in deciding whether to pursue a career in medicine. Medicine after all is about dealing with people, people who are in fact often suffering and at their most vunerable. Medical education itself is lacking in this aspect of teaching students about real suffering. Dr Berra described how he didn't actually learn about suffering until well after graduation when dealing with one of his own family members suffering with a terminal cancer. 

Dr Berra was very personable and delved into great detail about the personal experiences that shaped his medical career. He really pushed the importance of a good mentor, someone to share the experience of becoming a doctor, not someone who just teaches things now and there but someone who you can develop a real friendship with and can relate to your own experiences.

Two of Dr Berra's stories stood out (I have changed many of the facts, but the idea is the same). When he was just an intern only on his second rotation he was on a late shift and a young guy came in with gastroenteritis, flu-like symtoms, unable to walk. The patient became hypotensive and the decision was made with the team to give fluids, but the patients BP kept falling. Eventually the patient crashed and they had to give CPR for over an hour, and unfortunately the patient passed away. Later they found out that the chap had a viral myocarditis and perhaps fluids wasnt the best shout. 

The second story, a young guy came in after a horrendous crash after a snowmobile jump. the guy had landed flat on his back with the snowmobile on top of him. Almost every bone was broken, contusions everywhere and the spine was severed at C7. While looking at the CT with the radiologist and the team, the radiologist openly said theres no hope, what can we do, such a young guy paralysed for life. Dr Berra stood up and said lets at least try, come on. Later the father of the young guy thanked Dr Berra, he had infact been their with the team as they looked at the CT with the radiologist. The patient is now ok, many years on and able to move his hands despite the lack of sensation and mobility in his legs. 

The entire hospital was sued for the first case, many doctors became very defensive with their medicine after that. Medicine now is all about performance. People forget doctors are human and can make mistakes, and sometimes that mistake is just an inability to predict some outcomes in the future. Defensive medicine is an expensive way to deal with patients, both economically and in terms of suffering. Doctors need to also trust their own patients. A good doctor needs to do decision making without fear and in the best interests of the patients.

Dr Imber told a great story about how the editor of the NEJM (New England Journal of Medicine) became really quite ill once, needing to spend many days stuck in a hospital bed. The editor having been a doctor for many many years, only then realised how important nurses were to the patient experience. There is more to the patients experience than just the doctor-patient relationship. The patient deals with nurses, other healthcare staff, his/her own suffering and of course family and friends. 

I guess I've ranted on a bit now. In summary:

• If you are considering medicine, be around people. Try to gain experience in the human experience of suffering. Care homes for example are an ideal place to start.
• A good mentor is important
• Trust yourself and your decisions
• Never stop studying, even when you are well qualified
• There is much more happening outside the doctor-patient relationship in hospital for the patient
• Take your time with patient to take a full history and gain a complete understanding of their illness experience (10-15 minutes assigned time is a ridiculous concept). 

(Dr Joanthan Imber and Dr Lorenzo Berra, Humanitas Hospital Rozzano 2016)