Student of the Year Nominee!

I've been nominated for Student of the Year. (Oh, I forgot the "If you don't know how much I care, then get the HELL off of my website disclaimer). Professors or fellow classmates could nominate someone, and I was one of the someone's who got nominated. I feel really really honored that anyone would even think to nominate me. If I wish to accept the nomination, I need to turn in a current CV/resume and write 1000 words or less (or in my case, 1000 words-ish) about the following question: "How will the primary care focus of your osteopathic training prepare you for your future as a physician?" Below is my 1000 words-ish essay-like answer. Keep your fingers crossed for me!

I believe that because I have chosen to come to an osteopathic school, which emphasizes primary care, I have started down a path which will not only lead to my becoming a doctor, but will lead to my becoming an excellent physician. Medicine that emphasizes science teaches me how to deal with diseases, which is, without question, an important aspect of becoming a doctor. Medicine that focuses on primary care, however, teaches me how to work with patients, and this is what really prepares me to be a physician.

I am not advocating sympathy without science. I could have the best bedside manner in the world, but if I do not know the physiology of the body or the pathology of disease, I am no more than a witchdoctor with a bag of magic rocks, old wives’ tales, and good intentions. At the other extreme, if I were to leave medical school armed only with the cold hard facts that scientific research had to offer me, I could certainly set a broken bone or prescribe medications for illnesses or order and interpret blood-work and radiological exams, but without an emphasis on primary care, I would not know how to interact with my patients, and I would be lacking the skills required to truly facilitate a patient in the healing process. Like so many other things in life, then, a good medical education must consist of a balance

In the osteopathic tradition, I have been taught that the health of an individual rests on another balance—the balance between mind, body, and spirit. With the tools that science has to offer me, I can aid in the health of the body, and parts of the mind. With the primary care skills that I am learning—how to create a healthy and positive doctor-patient relationship; how to create an environment where the patient feels safe and comfortable, not only physically, but also mentally and spiritually; how to communicate to the patient and to other medical staff and doctors in a way that is clear and unmistakable; how to actively listen (not only by hearing what is said but by also tuning into what is not said but is expressed by body language or is otherwise implied) in order to take a good history, which is often the key to diagnosis; and how to take the time to educate the patients on their illness and their treatments, which will increase their understanding of the situation as well as increasing their compliance—that I will be able to aid in the health of the spirit and the parts of the mind that science has not yet learned to treat.

I am reminded of a passage in Act V scene iii of Macbeth, when the doctor comes to tell Macbeth that his wife is not physically sick, but mentally or spiritually troubled.

Macbeth: Canst thou not minister to a mind diseased,

Pluck from it the memory a rooted sorrow,

Raze out the written troubles of the brain,

And with some sweet oblivious antidote

Cleanse the fraught bosom of that perilous stuff

Which weighs upon the heart?

Doctor: Therein the patient

Must minister to himself.

Macbeth: Throw physic to the dogs; I’ll none of it.

I’m not sure what training doctors had in Shakespeare’s day, but I feel safe saying this doctor skipped out on his ‘Primary Care Skills’ classes. He does not know how to aid in the healing of the mind or the spirit—because the illness is not physical, he leaves Lady Macbeth to care for herself, (a decision which does not reflect well on him, since she kills herself before the next scene) and Macbeth loses all faith in medical doctors. The doctor is right, in a way, when he says that he cannot heal her; as doctors, we do not heal our patients, we simply use our skills to put them into position (physically, mentally, and spiritually) to heal themselves; but by leaving her with no hope for help, I believe this doctor breaks his Hippocratic Oath to “First do no Harm.”

Macbeth’s doctor was not the first or last to make such mistakes. There are many disgruntled patients today who do not believe in medicine and do not trust doctors. Many people stereotype doctors: Doctors do not really listen to them or believe them, doctors do not explain things to them in plain English, doctors never look up from their charts and are not personable, doctors just want them to follow-up so that they can get more money, etc. It is clear by these stereotypes that many doctors have lost the compliance and the trust of their patients, and have made the practice of medicine harder for the doctors that are doing a good job. I believe that it is my job, and the job of my colleagues to give medicine a better name. It needs to become the rule, rather than the exception, for a patient to go to a physician and feel like the doctor really listened, really made him/her feel comfortable, really took the time to do a thorough work-up and answer question, and that the doctor is on his/her side and is going to leave no stone unturned until a solution is found for his/her problem. My primary care training is teaching me to be this type of doctor.

Finally, I have learned that I cannot truly help anyone else achieve a healthy balance unless I am healthy myself. My primary care training has taught me to first make sure I am well—that I will have nothing to give to my patients if I am not giving myself the care I need. This is an ideal that has been a part of osteopathic medicine from the beginning, but is still ahead of its time. Medical professionals tend to be some of the most unhealthy people in the world. The time has come for physicians to lead their patients to a healthy lifestyle by example, and by doing so, revolutionize the face of medicine by preventing illness instead of curing it. If I am in a good state of mind, am physically healthy, and am morally sound, I am in a better place to create the environment that my patients need for their healing.

These are examples of some of the ways that the primary care focus of my osteopathic training has prepared me for my future as a physician.