smason edit.jpg (23187 bytes)Look At It This Way
by Steve Mason

We make some of our greatest gains
When we see old things
In new ways

Does Your Doctor Feel Your Pain? 

Did you ever get the feeling that your Doc couldn’t care less?  That may be a good thing.  A recent article in the journal Neuroimage reports that those healthcare professionals who feel your pain are far more apt to suffer personal distress, burnout and compassion fatigue. 


Many studies have shown that just seeing someone in pain can be more than enough to activate pain centers in the observer’s brain.  The problem here is that if a professional is swept up in the passion of the moment he may then be unable to marshal the cognitive resources necessary to provide any meaningful assistance.  “Ain’t it awful” is strictly for the panicked bystander.  “What the hell do I do now” is what you want from someone with training and experience.


The newest research compared readings from the frontal and centro-parietal regions of a doctor’s brain and a layman’s brain as they both watched a subject being pricked with a needle.  Electroencephalography indicated significant inhibition of emotion in the former.

But isn’t this common sense?  You just know it’s going to be the rank amateur who yells: Quick…Do SOMETHING…as a well-meaning member of the mob then rushes forward to hug the car crash victim and thereby sever his spinal cord.


But don’t get me wrong.  In the old days, bedside manner could count for a great deal as medicine prior to WW2 hadn’t progressed all that much from the Dark Ages of bloodletting with unwashed hands.  A physician who seemed to exude empathy could act as an effective placebo when there wasn’t much else available.  Today you have to wonder about the overly involved guy.  Might it be a sign that he hasn’t a clue?


I once found myself accidentally locked into a third floor day room with about a hundred mentally disturbed patients.  Making my way to one of the barred windows, I called down to three white coats that were walking below: “Hey…Help…I got locked in by mistake.”  Two didn’t even bother to look up.  The third merely smiled and then continued on his way.  True professionalism. 


On another occasion, still relatively new at the institution, I came across a David Niven look-alike sporting a green paisley ascot and reading the Times.  What’s wrong with this picture?  When I said, “You don’t look crazy” he gave an appreciative guffaw and told me his kids had him committed as a means of getting his money.  I listened to his story, was thoroughly convinced and brought it up at the next morning’s staff meeting.  As my colleagues tittered at my naiveté, the chief told me all I needed to know.  Clearly I’d met George…who never had any children and certainly never had any money.


By now you should have picked up on two points.  If you want to play for real, you never get emotionally involved and you always maintain your sense of skepticism.  I get picked on a lot by readers who feel I don’t show sufficient compassion.  Fantasy prone, they expect another Dr. Kildare…who began in the late '30s before antibiotics.  Interestingly enough, you’re less likely to get sued – no matter the damage you cause – if patients see you as caring.  One administrator told me he always knew the worst practitioners because they always had the best patient evaluations.  People will tell you they swear by their alternative therapists because…they listen.  Holding hands is, for some strange reason, seen as being truly efficacious treatment.  How many chiropractors does it take to screw in a light bulb?  Only one…but he has to do it three times a week for three months.  Ditto acupuncturists and homeopaths and herbalists and assorted other “ists.”  Is it possible that being nice is what they do because it’s all they do?


For a long time, I was involved in the study and treatment of acute and chronic pain.  I had done one paper that just naturally led to another and before I knew it, I was on a short list of grant-worth people.  What I learned during that period was how many patients create their own problems and how many then refuse to accept responsibility.  A lady shows up with leg pain.  Can it have anything to do with the fact that she’s wearing drop dead spiky heels?  A gentleman suffering lumbar pain can barely get his big belly up on the table.  Might trying to balance his front have anything to do with his back?  I also learned that some patients see their visit as a social outing.  A young girl presenting with refractory migraine was so keen on chatting with the staff, learning everyone’s name and life story that you had to wonder just how much pain she could be experiencing?  After a time she stopped coming and when a nurse made a follow-up call I told her to ask specifically about changes in the girl’s life.  It seems she found a boyfriend and son-of-a-gun if the headaches didn’t disappear.


Look At It This Way

A professional is there to do a job.  Anything beyond what is necessary to do that job should be carefully considered.  The sweet young thing in the front office is still dazzled by the lights while the older doll in the back office is dazzled by your insurance.  As for me, I’ll tell you straight.  I don’t know who said it first but the phrase fits: Let truth driven from any other place find refuge here. 

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