Leave me my idealism

I once shadowed a physician who made jokes for the better part of two hours about the numerous ways in which our medical system is broken. The punch lines didn’t make me laugh, and come to think of it, he wasn’t smiling as he delivered them.

We spend more time filling out paperwork than talking to patients, he said. These people – exactly who they are was never clear to me – demand the best care possible, thinking money will drop out of the sky, he commented. I hate insurance companies, he muttered. Stay away from primary care, he advised.

Things are not ideal for the profession, I see. Health care providers have their share of obstacles, from managed care, malpractice, insurance and government reimbursement, to long hours and strained relations with family and friends.

The refrain expands to the population at large. Costs are the highest in the world and rising, quality leaves much to be desired and 47 million remain uninsured. Perhaps some cynicism is warranted.

But actively discouraging doctors in training? Telling us that they wouldn’t do it again if they could start over? Constantly ranting about malpractice? I’m all for truth-telling and foregoing the sugar coating, but they must forget how idealistic and excited they must have been, and how such idealism and excitement was essential to their getting through school and loving their work, if they ever did.

It’s essential for reform, for improving care and for training a new generation of health care providers who are optimistic about the future. Persistent optimism is at the core of meaningful progress.

If my experience is a reliable indicator, in the guise of a reality check rife with discouragement and anger, they’re killing any optimism and excitement that hasn’t already been whittled away by an exam-to-exam cycle best characterized as an exercise in drowning survival.

Of course, it’s an exercise that turns out generally competent physicians. After residency, we’ll mostly know what we need to know, know when to look things up and where and how to apply it. But the qualities of the truly great ones have less to do with drowning survival or hard, pathophysiological facts and much more to do with things like passion, idealism, curiosity, resoluteness and empathy. Such things are vulnerable to both the rants and subtle jabs of grizzled old-schoolers.

I am sympathetic to my teachers and their attempts to communicate a bit of their knowledge. But, they also should allow us our idealism and perhaps a bit of its attendant naivete.

Another doctor I shadowed, wrist-deep into removing a brain tumor, quoted Shakespeare and quizzed me good-naturedly as I stood awkwardly off to the side, hands clasped in front of me. At one point, a colleague of the doctor came into the room to share with excitement the progress of another patient. It was electrifying to be around, and not just because of the blood and guts.

There’s plenty of time for me to get cynical. I just wish they wouldn’t push me toward it before it’s my time.