Yin and Yang of Medicine

I had no Plan B! From a very young age, I knew I wanted to be a doctor. Fortunately, I did get into medicine. I was a pretty lazy student, but did well enough to get an internship at the Royal Melbourne Hospital. It was then I discovered why I had a vocational call so early in my life. I really enjoy caring for people.

That’s what medicine is about – people – not just diseases and their treatment. We’re not passive observers of the passing parade, we’re in it up to our eyeballs. Of course we have to know our trade. But that’s the Yin. The Yang is our people skills – the communication and empathy needed to create effective relationships with the people we see. And you note I say “people” not “patients”. They are people first, patients second.

The question we ask whenever we see a patient – “Why has this patient come to see ME, HERE, NOW?” – is not just a clinical question. We need to understand the patient’s personality, their “backstory”, belief system, expectations, past experience with the medical system, and so on before we can properly answer that question.

So, here is some advice.

Don’t jump to conclusions about your patients’ expectations

Two examples from my experience (both true):

• A young woman who had a very large nose asked for a referral to a plastic surgeon. I started talking about rhinoplasties. She then pulled back her long black hair and pointed to her bat ears.
• A middle-aged woman came in and said she wanted to get a load off her chest. I settled back for a counselling session. But she wanted a referral for a reduction mammoplasty.

OK – silly examples. But I still had to find out what the young woman thought having flat ears would do for her. She thought they would remove a barrier to an international modelling career. The older woman wanted the operation, but was worried about her husband’s reaction.

Beware confirmation bias

When we first see a patient, we tend to make intuitive diagnostic leaps – and then find reasons to discard information that does not fit our preconceptions. The medical equivalent of surgical “time out” is to stop, just before shutting down the diagnostic process, to think, “Am I missing something here?”

Be kind to (almost) all of your patients

You will have patients that you just don’t like. They’re usually people with expectations that you can’t meet or aren’t prepared to meet. Gently point them elsewhere.

“I don’t think I can be the sort of doctor you’re looking for. Might I suggest you …”. But make sure the rest of your patients know that you’re genuinely concerned for their wellbeing; that they’re not just an abstract, interesting clinical problem.

Humility must trump hubris

This above all, to thine own self be true. (Hamlet Act 1, scene 3, 78–82)

There is one person you must always be honest with – yourself.

Dr Paul Nisselle AM
General Practitioner
Mutual Board Member, MDA National