RT @GlossopharNerve: maybe we should all have to enrol in acting classes too, learn to mask true feelings! > It’ll come without the classes!

Doctors hadn’t a clue what it was like, and I could see that they were uncomfortable when they were telling me everything would be fine.

I know when I was in hospital, I didn’t want pity or people trying to understand what I was going through.

On the whole empathy/sympathy/pity thing, I feel pity is demeaning, but empathy shows a true understanding of the patient’s suffering.

sorry guys, bit of a mix-up with presentation. Emailed it to Paul, should be up soon!!Apologies!

@arsmedica maybe we should all be forced to enrol in acting classes too, learn to mask our true feelings!

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@arsmedica most people in the world respond to kindness and interest, not all respond to professionalism!

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@arsmedica it may but what if the patient is psychiatric or would be if you could figure out what was wrong?

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@acousticnerve Can’t see it there. Give it another go? Or email it to me & I’ll post it for you.

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Hey all blog on Nuland’s is up!!

New ethical guidelines from Medical Council. See article from today’s times: http://short.ie/e7as2b

What about patients for whom you feel antipathy?

@GlossopharNerve But the trust may not depend on the doctor’s feelings for the patients. Clinical professionalism might instill the trust.

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@arsmedica sometimes we need the patient to confide in us in order to diagnose, if there’s no trust they won’t!

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@arsmedica I think it depends on the specialty…surgery of some sort, maybe not, but how are you to trust a GP if they simply don’t care?

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RT @phantomphanmj: Hospitals rooms are boring and they smell funny.

Do you, in fact, need to feel anything for a patient? Maybe all you need is a sense that it is your job to treat them professionally.

without empathy sympathy might just seem trite

sorry: that was supposed to be ” …you can HAVE sympathy without empathy…” (typo)

So it seems that you can sympathy without empathy, but having empathy makes sympathy more meaningful, because you really relate to the prob.

Apologies for absence. Fair play to those who have been tweeting (esp @GlossopharNerve – great info. Thanks). Hope anatomy went well 4U all.

@arsmedica empathy is when you can relate to someone’s problem whereas sympathy is when you provide support to someone with a problem.

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You can be aware of your mortality but when you begin to fear it is when it becomes a problem

Mortality salience – there are a good few papers written on it’s effects!

For something that may not exist, awareness of mortality seems to be a pretty recurrent theme….

“And I have seen the eternal Footman hold my coat, and snicker, And in short, I was afraid.” – Eliot.

“Pity is often condescending and may entail feelings of contempt and rejection.” Pity does appear to have very negative connotations!

There seem to be many differentiations between sympathy and empathy online, a definitive separation seems unlikely…..

empathy is used by clinicians to enhance communication and delivery of care, sympathy can be emotionally exhausting, leading to burnout.

Empathy – response to another’s perceived emotions by experiencing feelings of a similar sort. Sympathy also entails a non-fleeting concern

@arsmedica Pity evokes a tender or sometimes slightly contemptuous sorrow for people, a person, or an animal in misery, pain, or distress

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Awareness of mortality – having or showing realisation that we are in a state subject to death

mortalitiy – the state or condition of being subject to death

Aware – having or showing realisation, perception

Empathy, sympathy, pity? http://en.wikipedia.org/wiki/Empathy

Interested the in programmed death theory.

@HypoglossalN I don’t think they all do either, was just putting it out there as it was an argument that came up in class!

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At least, that’s the only way I can imagine they’d be able to cope with seeing people suffer all the time. Catharsis must play a big part.

I don’t think all doctors become detached. They remain sensitive to others by talking with colleagues and family about their experiences.

@OlfactoryNerve perhaps not if you follow the argument that we become detached and death has less effect!

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@arsmedica The “punishment” for failure is exponentially more severe than other professions. It must be passion that drives us then,no?

@GlossopharNerve Well, it certainly is a more demanding job than some & can “punish” more severely. Not to be chosen lightly!!

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maybe, maybe not! for those who don’t really want to be there as it may ultimately prove detrimental to their own health and happiness

Seems to be about a healthy balance of particular traits & motivations, then?& there are so many types of medicine: room 4 everyone perhaps?

@arsmedica though i don’t doubt many people go into medicine and are totally unhappy and unsatisfied there

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@arsmedica I don’t think anyone should dedicate their life to something they have no passion for!

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@arsmedica but then can there really be a drive to succeed without a passion for something?

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@GlossopharNerve You could be right there & might go further &say that passion is out of place. Level-headedness is what we need in doctors.

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take your pick! true some seem more nobel but if you’re willing to commit 100% does the incentive really matter? whether money or compassion

Vocation, mission, ambition, determination versus career, job, qualification, prestige? (“You’ll do orthopaedics , like your father…”)

@arsmedica but we can be driven by any of an infinite number of variables, we could achieve great things as a result of any of them!

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@GlossopharNerve But Kaplan might be implying that it made him more determined, more passionate. It drove him, while others just drifted?

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@arsmedica does it really matter what our motives are for pursuing medicine? if we have the drive to succeed the results will be the same

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Treves: “I conceive of him [the good surgeon] as a nimble man in doublet & hose who, over a prostrate form, fights Death with a rapier.”

@arsmedica why should it? it may develop coping mechanisms earlier but they’ll eventually develop anyways! It simply speeds desensitization.

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Might the challenge and thrill of their defence of patients against Death be more important to them than the patients’ actual lives?

In both texts the doctor character is deeply affected by what they witness. But how do they react? Why don’t they become revolutionaries?

“… keep it at bay through clinical detachment, clinical study… I concentrated on learning my art.”

“I felt dizzy, terrified at the thought of such contemptuous destruction. The only way to deal with that fear [WHAT FEAR?] was to …”

Kaplan mentions a “vertiginous awareness of our own mortality … Probably for the first time, I TRULY REALISED that one day I would die”.

To put question crudely: does more exposure to death & physical injury etc at an early stage make a better doctor?

@GlossopharNerve Ta for that. For anyone who wants the whole poem, tis here: http://bit.ly/2wQ4wS

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“And they, since they Were not the one dead, turned to their affairs.” “Out, Out” – Robert Frost. One brush with mortality….

Very interesting discussions today. Hope to see some follow up from you all up here over the next day or so before moving on to next texts.

Some doctors remember patients only by their medical history. Others remember the person and then recall the case. Does it matter?

Medicine is an “intense interface” between death-despair & life-hope; implying not merely a physical, but a philosophical function/goal.

The war against our own despair? Every victory is only a temporary respite from front-line devastation?

“Every loss diminishes us [Does it?], yet with clinical detachment … we continue, always in the HOPE of redemption.” A jaundiced view?

(Kaplan, now): So … doctors kill some patients. Bad decisions. Bad luck. Bad system. Medicine is abused.

Do doctors need to be especially observant? Strong on attention to detail? (Do only a few then also have the skill to put it into words?)

But suddenly I said sternly, in a voice that I did not recognise: ‘Camphor.’ > Why is this not HIS voice? Is it a learned voice? Med school?

When might a doctor WANT her patient to die?

…I saw respect in their faces. “All right. Very good, sir,” he said deferentially. > Has the narrator now got what he wants from patients?

Neurotic?

Full of self doubt., comparing themselves unfavourably to their seniors & peers, tormented by fear of failing (the consequences so serious)

Just like their patients, doctors especially young ones, are all-too human, fragile, proud, concerned about how they appear, being respected

.. repressing impulsive movements and to walk instead of running. … The attempt didn’t come off at all.

The young doctor was looking to be taken seriously so tried to develop a special manner designed to induce respect: talking evenly & gravely

Why “confess”- why does he feel guilty cursing the profession? He also says it was a burst of cowardice. He only whispers the curse. Revere?

Bulgakov: “I confess … I pronounced a whispered curse on the medical profession & on the application form I handed in five years earlier.”

As in every walk of life, newly qualified doctors are assigned to the least satisfying work in the least desirable locations.

I have a really strong feeling that I’m trying to walk the wrong way up a very very long escalator!

@arsmedica Yes in terms of evolution it is absolutely amazing! So complex *and* functional…

RT @acousticnerve: @arsmedica I think that becoming a doctor is a vocation >A vocation is a CALLING. Secular view implies a perfect fit.

@OlfactoryNerve That’s a fascinating area of speculation. But when you think about it as having evolved, it is surely overwhelmingly awesome

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@arsmedica Surely Human anatomy is the perfect argument against intelligent design… Even I could have designed it more simply !

Welcome to @HypoglossalN & @acousticnerve & @OlfactoryNerve – now you all just need to start following each other. Where are the others?

Welcome to @HypoglossalN & @acousticnerve & OlfactoryNerve – now you all just need to start following each other. Where are the others?

Not loving the idea of tweeting, never managed to keep a diary, inclined to think most passing thoughts are better forgotten not recorded…

Cool. Looks like it works. Well, I’ve had a read of that South African doctor’s memoir. Interesting. Makes surgery sound brutal though.

Test, test….1,2….does this thing work?

@arsmedica I think that becoming a doctor is so much more than just sticking medicine down as your first choice. It is a vocation.

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@arsmedica Medical school is just as tough as I expected, but it is also a lot of fun and extremely interesting.

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@arsmedica Some people are taking this studying thing to a whole new level!

Is medical school living up to your expectations? Are your fellow med students just like you in terms of their motivations?

Is your anatomy course giving you any new perspective on human beings paticularly that thing we call humanity?Is it changing YOU in any way?

Is the desire to become a doctor different from the desire to become an engineer? How?

Were there people you know who wanted to get into medicine but didn’t?Would they have made perfectly fine doctors?How do they feel about it?

What did YOU have to sacrifice in order to get into medicine?

“They did not ask why they wanted to serve, be humane, or to give. They simply felt like the right motivations…”

“Ming & Fitzgerald wanted medicine for the right reasons, they told each other: service, humanity, giving. …

“Because their motivations were clean, they were certain they deserved it more than those among them.”(Bloodletting & Miraculous Cures, Lam)

First meeting today. Hope you all enjoyed it & got something from it. Still need to hear from you all online.

Test for entry to medicine degree is ‘barrier for poor’ << http://short.ie/5yuxj4

RT @nzherald: 2 surveys of young doctors in NZ & Aust show they’re stressed & at high risk of burnout but love the work http://bit.ly/2ve0bf

Got a note from Vincent Lam wishing group well: “One of my first clinical tutors in 1st yr of med school was, I believe, educated in Dublin”

@OlfactoryNerve you’ll get the hang of it very quickly.

We’re going to be using Vincent Lam’s book Bloodletting & Miraculous Cures as our first text of the term: http://www.vincentlam.ca/index.php

RT @miss_carla: if i didn’t want to be a doctor so badly, i would just go to bed right now. but alas, my dream keeps me awake…and workin’.

RT @liapratitha: Sometimes I wonder Why most my highschool friends want to be doctors? I just don’t get it. Being a businessman is more fun

What drives people to become doctors? That’s one of the things we’ll be talking about on Monday. What makes a good doctor, too?

Remote Presence Robot being used in Tallaght Hospital: RTE1 9’Oclock news

Half of us have difficulty understanding their doctors: Artritis Ireland survey, e.g. many think ‘chronic’ means ‘bad or terrible’. (Indo)

A LEADING health official has described some medical consultants as “peacocks who walk around with their heads in the air” (Irish Times)

Communication is a process, not an event, & requires time & sensitivity. It may be part of a medical culture where death is seen as failure.

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