Kristin J.Blackwell, Clinical Social Worker, Kristinjblackwell@yahoo.com
Submitted May 06, 2015
I have been reading Neurology for several months because my teenage son has a new chronic, complex neurological problem. I am trying to learn about an area of medicine that I don't know as much about. I am disturbed with the content of the latest article "Better You than Me" - both as a parent and as a mental/behavioral health provider. [1] The tone of the article feels disrespectful to the patient who is a HUMAN BEING. I have worked in different medical settings for almost 20 years and unfortunately see this kind of attitude in physicians far too frequently. I would expect that a professional journal would choose to rise above this type of portrayal of a difficult patient. My guess is that if you talked to the patient, you might get a much different perspective. Good neurologists treat people fairly and don't judge. It is time to encourage physicians to treat ALL people with the respect and dignity they deserve. What if this was your family member? Do editors of the Neurology realize ANYONE can read these articles? While it may make for an emotionally interesting article, it seems unprofessional for this physician to have said that statement (the title of the article) to another physician. I hope they don't ever find themselves in the position of being a patient with an unusual medical problem.
1. Feld ED. Better you than me. Neurology 2015;84:1607-1608.
For disclosures, contact the editorial office at journal@neurology.org.
Editor's Note: This piece generated much discussion during the review and revision process. The reasons are likely apparent: this story depicts a reality of medical care that is difficult to discuss but that most of us recognize, in ourselves or others, that the practice of medicine is a human process, heir to all the weaknesses of humans. We are taught to overlook the patient's imperfect behavior because it may derive from their reaction to illness; but sometimes it is equally the case that the stresses of being a physician can result in behavior or attitudes that are less than desired. Neurologists are more likely than other physicians, even very busy physicians, to experience "burn out," with many unpleasant consequences. Needless to say, in publishing this essay we do not advocate the behavior illustrated; but we strongly support a forum that can express such realities, and welcome the discussion that may ensue. - Robert A. Gross, MD, PhD, FAAN
Section Editor's Note: Different people will read the vignette "Better you than me" from different perspectives. I agree that it is not, and I don't think is meant to be, flattering to the medical profession. I found the piece to be both well written and funny. It evoked vivid memories of internship--the feeling of being overwhelmed, the chronic fatigue and the indoctrination into medical gallows humor. I would call it a moral tale, and I suspect that, despite the advent of more rational duty hours, interns feel the same way now.
The letter writer seems to gloss over the author's point at the outset, which is honest, important, and little discussed: physicians inevitably encounter people they dislike or can't get along with, and this can seriously--even dangerously--cloud their medical judgment. Learning to recognize and examine such visceral dislike is vital to providing good care, as is being cautious about dismissing complaints we can't explain as psychological.
I also found the story thought-provoking in the way it addresses more complex issues about trainee supervision by senior residents and staff, and about the helpfulness and engagement (or lack thereof) by neurology consultants. Likewise, house staff pick up their attitudes toward patients from their residents and attendings, who may unconsciously impart less than empathetic attitudes. Those issues are still current and can always stand improvement. - Anne W. McCammon, MD, FAAN
I have been reading Neurology for several months because my teenage son has a new chronic, complex neurological problem. I am trying to learn about an area of medicine that I don't know as much about. I am disturbed with the content of the latest article "Better You than Me" - both as a parent and as a mental/behavioral health provider. [1] The tone of the article feels disrespectful to the patient who is a HUMAN BEING. I have worked in different medical settings for almost 20 years and unfortunately see this kind of attitude in physicians far too frequently. I would expect that a professional journal would choose to rise above this type of portrayal of a difficult patient. My guess is that if you talked to the patient, you might get a much different perspective. Good neurologists treat people fairly and don't judge. It is time to encourage physicians to treat ALL people with the respect and dignity they deserve. What if this was your family member? Do editors of the Neurology realize ANYONE can read these articles? While it may make for an emotionally interesting article, it seems unprofessional for this physician to have said that statement (the title of the article) to another physician. I hope they don't ever find themselves in the position of being a patient with an unusual medical problem.
1. Feld ED. Better you than me. Neurology 2015;84:1607-1608.
For disclosures, contact the editorial office at journal@neurology.org.
Editor's Note: This piece generated much discussion during the review and revision process. The reasons are likely apparent: this story depicts a reality of medical care that is difficult to discuss but that most of us recognize, in ourselves or others, that the practice of medicine is a human process, heir to all the weaknesses of humans. We are taught to overlook the patient's imperfect behavior because it may derive from their reaction to illness; but sometimes it is equally the case that the stresses of being a physician can result in behavior or attitudes that are less than desired. Neurologists are more likely than other physicians, even very busy physicians, to experience "burn out," with many unpleasant consequences. Needless to say, in publishing this essay we do not advocate the behavior illustrated; but we strongly support a forum that can express such realities, and welcome the discussion that may ensue. - Robert A. Gross, MD, PhD, FAAN
Section Editor's Note: Different people will read the vignette "Better you than me" from different perspectives. I agree that it is not, and I don't think is meant to be, flattering to the medical profession. I found the piece to be both well written and funny. It evoked vivid memories of internship--the feeling of being overwhelmed, the chronic fatigue and the indoctrination into medical gallows humor. I would call it a moral tale, and I suspect that, despite the advent of more rational duty hours, interns feel the same way now.
The letter writer seems to gloss over the author's point at the outset, which is honest, important, and little discussed: physicians inevitably encounter people they dislike or can't get along with, and this can seriously--even dangerously--cloud their medical judgment. Learning to recognize and examine such visceral dislike is vital to providing good care, as is being cautious about dismissing complaints we can't explain as psychological.
I also found the story thought-provoking in the way it addresses more complex issues about trainee supervision by senior residents and staff, and about the helpfulness and engagement (or lack thereof) by neurology consultants. Likewise, house staff pick up their attitudes toward patients from their residents and attendings, who may unconsciously impart less than empathetic attitudes. Those issues are still current and can always stand improvement. - Anne W. McCammon, MD, FAAN