08 June 2006


A commenter wrote:

Congrats on your transatlantic heroism! I did get a funny feeling reading the story though. I know it must be annoying to be singled out, especially amid the stresses of traveling. And as a non-doctor of course I can only imagine what it's like facing these situations. And I know that with a story like this where you practically need a triage center on the plane, grumbles about bad luck and inconvenience may be exaggerated for stylistic effect. Nevertheless, I can't help but be bothered by the cavalier tone. Put yourself in the shoes of the panicked woman, or the guy too short of breath to speak, and think about how you'd feel if possibly the only person on the plane who can help you is using iPod headphones to drown you out... Yeah, it must suck to be constantly "on call," but doesn't it kind of go with the territory? I always thought people wanted to become doctors because they were passionate about helping people.

Am I cavalier? Well, the title of this blog is "Movin' meat." so I guess the answer to that has got to be "yes." There are two sides of every medical interaction, and from the consumer side, it *always* sucks, whether you are seeing me in the ER or on an airplane or elsewhere. And from the professional side, it's always kind of routine (though less so over the Atlantic Ocean). But every day, I care for people who are afraid, in pain, etc. It's just not possible for me to give each of those people my full emotional empathy. I've got the compassionate mien down, so you could never tell, but inside my personal emotional state is (usually) a million miles away. Obviously, as any reader of this blog knows, some cases affect me more than others. An emotional distance between the doctor and the patient is almost necessary as a defense mechanism, a survival trait for the doctor.

To those who see behind the veil: the family member who stops and listens at the nurses' station, non-medical persons who read this blog, etc, it can be more than a little disconcerting to see the emotional disconnect. It's hard to understand how a doctor can walk out of a room with a dying patient and grieving family, and seamlessly switch gears into laughing and talking about baseball. Until you have done it, it's hard to really wrap your brain around the fact that, to us, "It's just a job." Not that we don't care about it, not that it isn't important, but you don't bring your work home with you. So to speak.

I'm reminded of one time I was sewing up a laceration on a teenage girl's arm. She was a bit weepy and anxious, and she *hated* the anesthetic injection. As I worked, we chatted, and she said that she had wanted to go into medicine, but she didn't think she could handle it. "I don't understand how you can do this," she said, "Isn't it hard?" I thought for a moment and said, "No, not really. It isn't my arm."

As to "Next time," well, last time I swore that I wouldn't answer the call, but I did. Maybe I will suck it up again. Maybe I'll follow the advice of a partner who confided that as soon as he gets on the plane he has a few drinks so he *can't* answer the call -- now that is cynical! Who knows?


  1. This is a straight copy from my post in the previous thread:


    I wrote about this a few posts ago in this blog and I want you to know that your feelings about this are really shared, and to some degree inevitable. I know the author of this blog very well, and as I said before, knowing him and some of our other doctor friends was at first pretty unnerving. I've seen these people sick, angry, careless, drunk, goofy, mean, etc. At first I had that reaction of, "Are you really going to be handling people's lives and health?!?"

    Then you slowly come to see that their humanity is inevtibale, and even more, a benefit. As the author says in a later post, the divorce of his emotions from the job is survival to him. Would he do a better job were he emptionally invested in every case? That's hard to say, I wouldn't want him responsible for his own child's urgent care -- not that he wouldn't do a fine job applying atiseptic or even setting a broken arm, but if his child were really in serious shape, I couldn't imagine him having the clarity or dispassion he'd need to make the right decisions (necessarily). In the same sense you could argue that a big emotional investment might be counter productive. His job is to keep you alive, not keep you happy (he is an ER doc, obviously this is a different equation for a different kind of doctor).

    Even if we agree that he could do a slightly better job if he were emotionally invested, I would imagine his career would be limited to a few years and burnout. I burned out of a certain aspect of my job that was stressful, and I was dealing with issues costing companies about a million dollars a day -- I can't imagine the burnout potential of a job that could cost individuals the lives of their loved ones.

    So although I know how you feel, and I totally get your perspective, I have to respectfully disagree and continue to hope that doctors as skilled as our author can continue to defend themselves in whatever way possible to get the job done right.

    And he didn't address it, even in his follow up post, but I know him too well, he's not going to fail to answer the call.


  2. Why is it that people fail to see doctors as human? I suppose it surprises me that in this information age there are still the romantic views of a doctor. I guess I know too many doctors personally and professionally to see doctors as heroic figures.

    I won't repeat what MSD said - I agree with what he said about answering the call.

    This comment brings up another thing I have been thinking about. How do the medbloggers feel about the general public (non-medical types)reading their blogs? I have just started reading them and as a way too frequent consumer of medical services I really enjoy a glimpse into the other side. Am I an interloper if I comment on posts clearly meant for other medical types?

  3. Matt -- Thanks for the kind words.

    Susan -- I know that I try to write for an audience which is both medical and non-medical. For the rest, I can't say how they feel, but if the submission directions for the medical grand rounds is any guide, I think that most are as interested in the lay audience as the medical. The submission guidelines read:

    Remember, the target audience here is NOT other medical bloggers, or people in the health care industry. It's the educated but nonmedical readers coming from general-interest blogs. So write for that audience, if only for this one post (even if your blog is about echocardiography). The idea is to introduce the wider world to the growing medical blogosphere -- the doctors, nurses, students, administrators, EMTs, techs, and patients who blog.

    And from reading the comments on most blogs, I would estimate that more than half are from folks with a patient's perspective. So, no, you are not an interloper.

  4. I just came upon your blog, and I've enjoyed your postings. I'm an RN in a metropolitan ED. Before I go on shift, I put on my "teflon skin." That's the best description I can give. Of course I am compassionate, but I can't be effective over the course of a shift if I take in all that humanity.

  5. Funny when I read the original flight dispatch my thought was 'Wow I can't believe this guy has to do this. Great that he can but isn't he terrified of some freak on a plane going all malpractice on him when all he did was stand up and be a superhero because they ASKED HIM TO?'

    I mean doctors are such targets even at their offices with legal papers and medical histories and charts and tests - seems like even giving someone on a plane an aspirin is putting their career in danger. I think the doctor who stands up on a plane is a MONDO superhero.

  6. I must say, I would really prefer that my doctor be dispassionate and objective. (1)Emotions cloud judgement and (2)I'd feel kind of intruded on if she were to be very touchy-feely and empathetic.

    The fact that my doctor worked and studied umpteen years, and now is willing to shoulder some responsibility for my health, is proof enough of caring. There are plenty of other ways, ways that don't require being on call or going into enormous debt for med school, to make money.

    No one should expect thier doctor to be a saint.

  7. No one should expect thier doctor to be a saint.

    Well, that's good because a saint I am not.

    Great that he can but isn't he terrified of some freak on a plane going all malpractice on him when all he did was stand up and be a superhero because they ASKED HIM TO?'

    Superhero maybe, but not because of my malpractice-defying courage. There is a "good samaritan" law that exempts physicians who help out in this sort of situation. Fortunately. Otherwise, I would probably ask for a waiver before offering to help out. . .

  8. Very interesting. I never picked up on a "cavalier tone" in your post about airplane medicine. I thought you did an excellent job with the people and problems you were presented with. And I appreciate your honesty about your humanity, your feelings, your teflon skin. We all have it. We have to, as you say.

    To Susan: As a physician and blogger, I'll say that I expect that most of my readers are not medical, and I write accordingly. I appreciate feedback from anyone and everyone, as I see Shadowfax does as well.


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