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Community and Maternal Health
Exploring how community support can transform maternal health by reducing isolation, improving menta...
The definition of a doctor per the Oxford dictionary: “A qualified practitioner of medicine.” What does that mean?
The definition of medicine per the Oxford dictionary: “the science or practice of the diagnosis, treatment, and prevention of disease.”
This was of course my expectation going into medicine along with the deeper desire to “help people.” Over my years of work as a physician I have come to realize that the “practice of medicine” alone is not always “help.”
Let’s say I see a patient for a fetal anatomy scan. On the ultrasound there are findings- “soft markers” indicating there may be an increased risk of a genetic abnormality like Down Syndrome. I give her and her partner this information and offer genetic screening vs genetic testing. This information and offer alone are technically medical practice but without further investigation into what the patient and her partner desire to know about their baby, how they feel about genetic screening and the context of the risk (soft markers are very very common and often result in genetically normal babies- testing can help identify the less common ones that might be affected) or giving them time to process and digest this information- I am not necessarily “helping.” I know this because I didn’t understand I might need to do more when I first started practicing medicine. They don’t teach this education and support component as well in medical training. It is something you can learn with good mentoring, empathy and experience. I have had both patients and clients complain about getting diagnoses and treatment recommendations without any further information or supper and boy is this unhelpful. It breeds distrust and resentment in the medical system.
This education and support aspect is where I find I spend most of my time as a physician now in these scenarios. Letting the patient digest information, helping them understand it and working toward shared decision making regarding next steps. There is no cook book answer- each patient is a microcosm of their own universe of experiences, culture, desire and understanding. I cannot expect the same from all. This process of connecting the diagnoses and management options to the individual and their needs is the true art of medicine- it is where the actual healing happens. Not only do they need support in the moment but ongoing support for whatever is going on. When I give a new diagnoses I often tell patients they can call and ask questions or schedule a follow up for questions if they need to later because in the moment they are not always able to process the information.
Moving more into my role as a coach vs physician- I find this is an area where I get to focus less on diagnosis and evaluation and more on support. Not giving any medical advice but offering more context, validation and support to their situation. In coaching I have the time and space to do this more than I did at the hospital where patients had to be moved through and productivity goals and schedule algorithms put more value on ultrasounds performed than patient discussion.
Both roles allow me to be a healer- one more in the medical sense and the other more in an emotional support role. Ideally I get to do both. To do that universally we would need a system that values this kind of holistic medical care and we definitely are no where close to that in our mainstream healthcare system, where time with doctors is dictated by insurance companies, administrators and financial bottom-lines.
What gives me hope is the number of physicians I see creating their own network of private practices, ideal clinics and otherwise unconventional medical set-ups so that they can spend more time supporting the individual needs of patients and community. We need to keep being curious and creative in the ways we can “help” as well as advocating for systems change in a larger level.
