A taste of their own medicine

To get a place at medical school you need good exam results and it helps to have worked in a hospital. But you don't need to have been sick. At 18 there's not been much opportunity for serious illness, but selection committees could favour candidates who've had appendixes removed or suffered from glandular fever. Patients with chronic diseases can find it hard to believe a young doctor, glowing with health, can know what it feels like to be so wracked with pain they can't tie their shoelaces.

Maybe it's too much to inflict pain on doctors to make them empathic, but there's now a virtual reality experience that can simulate exhaustion. Although junior doctors may argue they already know what that feels like, My Steps (funded by a grant from a drug company, and supported by the charity Cancer Bacup) recreates the overwhelming fatigue of cancer patients. Doctors are taught to ask patients how their disease restricts their lives, but there's a temptation to focus on what can be treated.

Some chemotherapy regimes are totally debilitating, but patients may not discuss fatigue because they don't want to complain or be thought ungrateful. Fatigue is a small price to pay for life. Yet a friend described his chemotherapy as making him too tired to lift his head from the pillow. Anything more than watching the traffic was too much. Some days he was so tired that he thought dying might be better.

The virtual reality cancer fatigue means sitting in a chair with foot pedals, wearing a head-mounted display through which you see the environment. This is Ed and Grace's home and you move around the rooms, making tea, answering the door, with increasing difficulty as the foot pedals get heavier to move. If you move your head display too far you can get an extra patient experience - dizziness and nausea.

I've only seen the video, shown in Brighton last week at the British Society of Haematology meeting, to educate doctors about the fatigue that accompanies anaemia and leukaemia. There is no guarantee that any form of suffering, however artificial, makes someone a better doctor. There are many things which make some doctors better than others, and some are nothing to do with how caring you are. You could be an excellent doctor, hard-working and up-to-date with the literature, with good technical skills - but heartless.

But now that we live in a 'compassionate society', doctors are increasingly expected to be caring about their patients. Medical schools include teaching on how to be empathic. Some have medical students work as trainee nurses on the ward (the wiping of bottoms is a great leveller), others employ actors to help hone communication skills. It's advisable to teach doctors to be sympathetic, if only because patients are so frequently upset after seeing them. The only real way to do this is to be a patient, or closely related to one.

I became a doctor because of a romantic idea while lying in bed for a month recovering from spinal surgery. I wasn't grateful for all that had been done for me, but angry and hurt. Before the operation, a group of medical students had shuffled around me looking bored. I was barely clothed, 17 and shy. 'As you can see her spine is bent to the right and really she is quite deformed,' said the registrar cheerily.

I walked round the shops with my mother afterwards sobbing, 'It's your fault -you made me deformed.' Only a 17-year-old would embark on a career because someone's been rude about your body and a belief that you'd be nicer to patients.

But the BMJ and other medical journals are always full of stories from doctors about how their experiences of hospitals changed their lives. Just as normal people are rendered inarticulate and powerless by a doctor, so, often, are doctors themselves. Writing about being in hospital with kidney disease, befuddled by taking steroids, a GP described ward rounds. 'When my bed was surrounded by the medical team, I felt like a fish in a pond, looking up at people standing on its edge, not knowing how best to influence them in the discussions they were having about me. They seemed to be ignoring me.'

While it's not feasible to give trainee doctors a taste of their future medicine, it's possible to select students who've had more experience of life. But selection and training can't eliminate the factors that make it tough for the kindest doctors. Many doctors feel ground down by overbooked outpatient clinics, teaching and research commitments and paperwork. They have increasingly informed patients who want proof the treatments are effective. Sometimes they have to tell patients there's no money to pay for the most effective treatment. Now that would make a good virtual reality ride for patients.

Thanks to guardian.co.uk who have provided this article. View the original here.


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