In Defense of Medicine: Why Doctors Do as They Do

I would like to elaborate a bit more about the reason for satire of physicians and medicine. I hope this isn’t too rambling as I try to express my thoughts.

The satire of doctors and the profession of medicine has gone on for ages and surely it will continue to go on. Everyone will have their laughs and maybe as suggested will feel a bit more cheerful about the unknown. And I think there have been good reasons for society taking the harder look at medicine, scratching their heads and then finding humor in what they feel is the unexpected and the unwelcome part of the profession. Why is it that the public doesn’t understand doctors and their behavior?

I think there are explanations for the way doctors do their job and how they behave and the public may really not be fully aware about them. The behavior starts with consideration of the job. Becoming a doctor nowadays requires our own hard look at what we are getting into. Whether one goes to a private or a state run medical school, it is expensive. The expense has a large monetary dollar sign but also one will be spending a significant part of one’s early life just studying to be a doctor. And that studying can be at the expense of a starting family life or years of missing an income amongst other losses. The hard look also looks ahead to the career, often without stable, readily calculated working hours. Yes, many hours will be rewarding and ego-boosting as a true professional. But there will be the hours of frustration and uncertainty that are handmaidens to the doctor and his or her work. Sometimes, when busy doing doctoring, a doctor will go from a encouraging high to a discouraging low all in the same day or part of a day or even from patient to patient. And there is a lot of self-reflection. What did I do right? What did I do wrong? What will happen with the next patient? Sometimes physicians have to develop behavior techniques to mitigate those feelings that can lead to discomfort. Doctors are under observation by their patients, their colleagues and others and always at risk of getting sued for malpractice. This leads to a defensive practice behavior that may be misunderstood by the patient. These investments of money, time and emotions all affect how the doctor behaves attending to a patient.

I think that the public can’t understand what doctors are all about because they don’t know about the “split personality” that is part of being a doctor. From the very beginning of medical school out to the professional practice of medicine, we are morphed from one into two personalities. There is the white coat part of the physician who has been indoctrinated from the beginning into a guild of doctors with their own special speech, special thinking and behavior and special requirements of practice and ethics. This is indoctrination and not being simply taught to “act” as a doctor. But there is also the original personality and character of that body and mind which is still present and who simply wears the white coat at work. This “split personality” provides the basis for conflicts involving communication and behavior. Being the guardian of medical resources, those in the white coat find that a paternalistic approach to communication with patients most natural and what many doctors feel is expected. Also, with the need to care for more patients in a limited time, paternalistic communication is the more efficient. Being also a husband, wife, mother or father with family responsibilities leads at times to attempts to avoid doctoring responsibility in favor of the family. This can produce inconveniences or worse for the patients. Patients now come to expect less paternalism and more dedication of time and interest by physicians to their own complaints. When this doesn’t happen, patients may become disillusioned with the doctor.

In conclusion, I believe that the public has an image of a physician which is based on some historical character, some wise, caring, idealistic and altruistic character, which is the representation of all doctors, particularly expected in their own doctor. The patient expects the doctor to be this unified imagined character, especially when they are sick. If they see doctors as pompous, paternalistic, uncaring and greedy, intent on their own self-interest, the doctor and the medical profession becomes the subject for satire. What is missing in the understanding by the public is the fact that all doctors are as human as they are with many of the same foibles they bear. Most doctors try to create a persona that attempts to deal with and do right for the patient despite their own burdens including the burden of trying to live and practice medicine with their “split personalities”. ..Maurice.