[ancaster]

Thank you for posting this. I'm just starting out on a career in medicine myself, and I often wonder how to make it through this with my sanity intact. The idea that the career demands "the subsuming of my inner life" seems cruel and, I hope, not inevitable. Isn't there room to feel our feelings in this job, and not necessarily be ground down by them?

[bearsnowstorm]

As an intensive care specialist (what would be called an attending in the US) I find it best to control my emotional response to my job. Also, empathy is probably not as wise as compassion in this context, from a career longevity point of view. If you find during your training that you have difficulty setting emotional boundaries and regulating your emotional responses, consider choosing a specialty with fewer unhappy endings (though probably not something with a strong pattern recognition component such as radiology or anatomical pathology, given technological progress in that area - you'd have to expect that we will need less of them as time goes by). There's lots of scope to do less emotionally taxing but still very useful and satisfying work if that fits your aptitudes better.

[ghufran_syed]

Some of the best advice I ever read on this subject, which really helped me through residency training was from the little essays at the beginning of the Oxford handbook of clinical medicine [1]. The one I particularly remember was called "On being busy", and taught a generation of UK medical students and residents about "Corrigan's secret door" (the link hopefully shows that page on Google books). My favorite quote from the book was about how to recognise "stress" in yourself: "stress is defined as arguing with more than one nurse in 24 hours".

The book was affectionately known in England as the "cheese and onion book", because the colour of the cover matched what at the time was the traditional colour of packets of cheese and onion flavor crisps in the UK [2]

[1] https://goo.gl/6Pz1Z1

[2] http://www.dailymail.co.uk/sciencetech/article-2293465/A-che...

[mrkgnao]

Thank you for the link to that book.

I sometimes ponder, against my own experience from experiencing the mathematical side of things, how the "folklore" wisdom in the medical community is almost certainly something that the rest of us might benefit from (this probably started when I read The Emperor of All Maladies a couple years back) considering the issues that the mental part of it deals with: ethics, conduct in a power-unequal relationship, consent, the moral imperative to evaluate risk competently (and the recognition that the former can never be done perfectly), telling the truth and intention/effect differences ("you're almost certainly going to die"/"this is a miracle!"), not to mention the elephant-in-the-room question of living with death as a close acquaintance and learning not to become consumed with either anger or despair at what one considers personal failings.

(I suppose the late Oliver Sacks's work is an instance of what I'm talking about.)

[ancaster]

Thank you for sharing that; I was able to read "On being busy", and it is lovely.

[ssivark]

For those who are unable to grasp the emotional impact of dealing with patients, I would like to mention that Erich Segal's novel 'Doctors' helped me appreciate it better. I found it to be a fascinating read: https://www.goodreads.com/book/show/91201.Doctors

[paviva]

There always be room for feelings, and empathy, but those will manifest only when you're not doing the technical job of medicine, i.e. the part of the job that will require your full attention and the full use of your skills.

This will come naturally with expertise, and is not a state of mind where you actively "force" yourself to stop caring, but rather a kind of single-minded flow[1] where you can only feel completely relaxed and at peace with whatever's happening. This is important because it allows to function at your best and ensures you treat all you patients to the best of your ability, because your immediate motivation is not their wellbeing, but staying in the flow.

What do I mean by those "technical" acts? Anything that requires fine-tuned skill. Everybody thinks of fine-motor procedural skills (surgical techniques, intubation, difficult LP), but purely mental skills are exactly the same. Getting a history from a patient while forming diagnostic hypotheses feels good.

Of course, as soon as you'll be delivering bad news to your patients, you want be functioning like a highly skilled worker but as a fellow human being who can't do much more than commiserate. You wont be in the flow, and you wont feel any less for your patients just because you're the doctor.

[1] https://en.wikipedia.org/wiki/Flow_(psychology)