YOUR DOCTOR ISN'T YOUR SOCIAL WORKER:

A Young Doctor's Hardest Lesson: Keep Your Mouth Shut (KENT SEPKOWITZ, M.D., 12/28/04, NY Times)

[L]ast month, my wife and I bumped into an acquaintance of hers while walking along the street. The person, unbeknownst to my wife, is a patient of mine, someone whom I treat for a chronic infection. After the patient and I shared a moment of mutual panic, we three chatted amicably and moved on.

Except, that evening, my wife kept asking me why I was being so quiet and, well, boring. And I suddenly saw the problem: doctors are waterlogged with secrets, hundreds of them, thousands of them.

Each day brings a new batch: patients' admissions about drug use or sexual indiscretion, a hidden family, a long-held dream, an ancient heartache, undisclosed H.I.V. infection.

Over the years, this begins to add up, the bulge expands, the joints get stiff. Yet the secret - the consequences of our ever-expanding repository of others' secrets - remains, well, secretive. The situation simply is not addressed, not at the start, middle, or the end of a career.

The most difficult aspect of a training doctor's life is not suddenly bearing witness to someone else's pain and death; it is not adjusting to arduous work hours; it is not the imposing amount to be learned and synthesized. These surely are intense, life-transforming endeavors but are still related to other experiences.

No, the biggest shock along the road to becoming a doctor is the startling revelation that you can ask and the patient will tell anything.

The hard part is shutting them up.

Posted by Orrin Judd at December 28, 2004 8:37 AM