Us and Them: A Medical Student Reflects on the Doctor-Patient Divide

Don’t hold the door to the psych ward open for anyone. This is what they told us before we visited for the first time. It’s a matter of policy: some of the patients locked inside have tried to hurt themselves or others. But the impact went deeper. These people are the Other, the message seemed to be. Different from us. It didn’t sit well. Aren’t we supposed to empathize with our patients, to find our common humanity?

Yet it’s a message we hear often in med school. Not explicitly, of course; time and time again we are reminded to level with our patients, to treat them as whole people, to respect them. But almost as often, a lecturer introduces a new disease by compare and contrast: If I ran this test on you guys, they say–meaning healthy people–it would look like X. In a patient, it could look like Y.

Statistically, that’s true. But you never know. The white coats and scrubs we wear declare that we medical people are the healthy ones in the hospital, among the few who go there voluntarily. Underneath that armor, though, we’re just as fragile as anyone else.

We spend our days learning about all the forms that fragility can take. That leads not just to the familiar “med student syndrome,” in which we use innocuous symptoms to diagnose ourselves with every disease in the textbook (although there’s some of that) — but also to something more. Seeing patient after patient who has tumbled over the precipice from health to illness reminds us that we live on the edge of a cliff.

I’m thinking of the woman this year–just around my mom’s age–who had always felt healthy but woke up one day to find that lack of blood flow to her brain had left her unable to understand language. And there was the young man I met last year, another young professional about my age, who had been hit by an SUV crossing the street and was at four surgeries and counting. He hadn’t even been jaywalking, but unlike most New Yorkers, I rarely cross against the light anymore.

Absorbing too many stories like that can start to get to you. Seeing oncologists plan end-of-life care for a kind, 40-something man with a young family can distort your view of what life is likely to bring. I have to remind myself sometimes of all the people I know who, despite the odd ailments, aches and pains, have made it to a ripe old age more or less intact.

So I find that I’m starting to understand the us-and-them attitude–the desire to pretend that the ultra thin line between doctor and patient is a bit more robust. It can be existentially exhausting not to. For the good of my patients and myself, I’m learning how to strike the balance between putting myself in the patient’s shoes and standing tall in my own.