Manual Over Autofocus.

I am astounded that in a month I will be one half of the way through my third year of medical school. As I've gone through a handful of rotations and have spent more time than I cared to at the hospitals, I've noticed something that has been irritating me. As a student, for as much as we are active and participating in patient care, we spend a lot of time observing. We watch residents, attendings, and nurses, seeing how they interact with patients and approach the art of medicine. The mantra that is often taught, or supposed to be taught, or ideally taught but secretly thought by some of those teaching as foolish, is that in medicine you should not treat the disease; you should treat the patient.

The sentiment of that statement rings true with how I feel. The execution? Not so much. Many physicians stop short of treating the disease, let alone the patient. Instead, they treat the symptom or a specific manifestation of the disease. An ID doctor treats the infection; the surgeon opens and drains the abscess; the endocrinologist manages the diabetes. This makes sense from a practical point of view. If I have learned anything over the past two and a half years it is that I cannot learn everything. An expert should handle the complexities and nuanced management of certain conditions. But what happened to treating the patient? (This is not to say specialists cannot treat the patient instead of a symptom or aspect of disease; it simply means I haven't seen it yet. I am wanting to, believe me.)

Recently on rounds, the attending reminded us that "In medicine, we treat the patient, not the numbers." This statement was made regarding abnormal lab values. It was meant to remind the students and residents that we cannot simply try to correct abnormalities on paper; we must look at the patient clinically to confirm, adapt, and change plans. Sadly, it was meant on nothing more than a level of clinical correlation. As opposed to a grander statement about the lofty responsibility of treating the patient, it was about confirming laboratory findings clinically. What this statement actually did for me was point out the failures of the medical team to go beyond a talking point and treat more than the patient; I instead wondered: what about the person?

Too often it seems medicine becomes bogged down in labs or physical findings. Sodium is corrected; cholesterol is monitored. While these things are astoundingly important, I do not want to be a physician who works through tunneled vision. I do not want to be a physician who treats the patient instead of the disease.

I want to be the doctor who cares for the person.

Most of the people I have worked with thus far- who no doubt care about patients immensely and typically practice good medicine- do not focus on the patient as a person. Maybe this is naive and foolish. Maybe I cannot actually appreciate the weight of what it means to be a physician and all its struggles because I haven't reached that point yet. Honestly, I do not know and don't get me wrong: there have been a handful of docs who continually impress me both with their control of medical knowledge and their approach to patient care. Such physicians do exist. I just suppose my hope is to join their ranks in one and half years (technically) and four and half years (board-certified-ly).



Until next time.