To give health or to bring about damage

Hundreds of thousands of words are spilled in scientific and general press on the syndrome of the burned doctor. Tremendous articles on the suicide between doctors, subject very debated in countries of English speech.

Whole decades military, as much buried as open, between doctors and nurses, reflected in countless academic articles and tweets of reproaches and mutual accusations. Ended in Spain with a Real Decreto who denies to nurses the capacity of prescription of the drugs on which they study hours and hours in the Faculty and that spends through their hands day after day in the exercise of their profession.

Hospitable specialists who look over the shoulder at the general doctors €œwho they do not have nor idea€ of €œhis€. Doctors of family who think openly on the €œpublic danger€ that the specialist constitutes for her patients.

Still nowadays, 20 years after home to work as doctor, I go with certain sorrow to the equipment meetings, although he has been years tried to forget the old confrontations, the malicious commentaries, the accusations of errors and negligences. The war to be some over the other, in which I also have participated and without a doubt I have made damage to some companion. Until a day I realized of which they phelp to me to treat patients, not to be upon a colleague in an anodyne discussion.

Solidarity

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HOW IT IS POSSIBLE TO EXERT A PROFESSION THAT IT LOOKS FOR TO TAKE CARE OF THE HEALTH OF OTHER PEOPLE, AND AT THE SAME TIME TO BEHAVE BADLY WITH THE COMPANIONS AND ONE SAME ONE?

As Ranjana Srivastava in its article of The Guardian says (How doctors treat doctors May sees medicine's secret shame), we do not know how much responsibility of the syndrome of burn-out resides in the long working hours, the means shortage, or perhaps in the daily confrontations between professionals.

Still memory that one guard as resident of first year in the general Urgencies. My resident supervisor ordered to me to prescribe average blister of metamizol to a patient with lumbago. As to the 3 hours he did not yield his pain, he asked to me that it ordered another average blister. The nurse fired to me €œif you were a little lists, you would have told me that he kept the average blister to put it now. By your fault we have squandered medication€. Certainly, at that time it felt to me little intelligent. It took all day of guard giving returned as a duck navigated, incapable to make a medical decision by same me. Although it would know rationally that it was normal, that would happen with time, that all we had been inexperienced someday, that one phrase struck me in deepest.

Another morning, in operating room, one of the associates threw some scissors against the wall, while it shelp with abruptness to instrumentalist €œthese scissors do not cut, deme some decent scissors€. Although all we would know that the state of the scissors did not depend on the instrumentalist one, the reproach remained hanging in the saddened eyes of the nurse, that were reached to see after the glasses and the surgical mask, while new scissors looked for some nervously. And an operating room nurse told me only yesterday how he had ended up crying of impotence in clothes several times by the lack of help of his own colleagues in the first weeks of work.

YOU BELIEVE IN THE HEALTH AND THE CARE OF THE ILL PEOPLE? IT TAKES CARE OF THEN OF THE HEALTHY ONES AND OF THAT YOU HAVE CLOSE MORE, INCLUDING YOU

How it is the atmosphere in your class? By the Medicine Faculty in that I give classes run histories appellants of delegates who €œforget€ to pass notes of the professors; of classroom companions who take their notes with ball-point pen from green color so that nobody can photocopy them. Of examinations of previous years that fall into the hands of some groups and that are not shared with the rest of the class.

Great fault of this probably has it the fact that, in many subjects, the cutoff grade to approve calculates from 75% of 5 or 10 better notes. This automatically generates fear and resentment towards most studious of the class. Ah, the bell of Gaussian€¦ To the thread of this, memory the one of my companions of Faculty loosen to me phrase: €œWhat you are created, although you remove very good notes, in the end I am going to end up the same working and we will arrive at the same site€. And another companion protesting the acts of qualifications to find out if he had obtained a honour degree, €œbecause this is very important, Almudena, on this matriculation can depend that someday he arrives at Head on watch€€¦

This is not an exclusive problem of Spain. As Ronald M. Harden in Chapter 2 of the book says To Practical for Guide Medical Teachers, €œ[€¦] it is difficult to develop in students to spirit of teamwork and collaboration if the environment in the medical school is to competitive to rather than to collaborative one €œ.

It seems that the hidden cultural values of the faculties teach quite the opposite to us of will be it our future real life. Thus, we lived a fiction during the race in which:

  • doctors and nurses and physiotherapists and psychologists do not know everything of the system of study of the others
  • we ferociously compete against our companions removing to a good approved note or a simple one
  • it seems to us the communitarian medicine not much and we admired the specialist
  • we are created in the peak of the system to study Medicine

And all this contrasts with the pure and hard facts:

  • you will work closely with other professions and you will have to know and to facilitate his work by the good of the patient
  • you could not be independent with absolutely all patients, and constantly you will need the help your colleagues
  • you will end up discovering that the good operation of the Communitarian Primary care and is crucial for the health of the population and the control of costs, and your abilities of specialist will be only a small part of the well-being of your patient
  • the doctor will learn of nurses, helps and physiotherapists which never discovered in books and their help will be crucial in the first years of their race, and to the inverse one

PLANT to YOU: HE TAKES CARE OF OF YOU, HE TAKES CARE OF OF YOUR COMPANIONS, HE LEARNS TO BEING A GOOD PROFESSIONAL OF THE HEALTH

You do not leave happens what the Dra. Wible denounces in this interview on the incidence of suicides in doctors of the USA (€œRight now students feel extremely isolated, and that just you continue through our entire profession. We plows in a culture that glorifies self-neglect €œ).

One is not to follow next to who tries to you bad. Move away to you of the toxic people and learn to being considered as first step for the future with these 6 advice:

  1. You do not hate the companion who removes so good notes, because perhaps he has learned to sacrifice something that you do not sacrifice; perhaps it is very only; perhaps it helps you willingly in what one occurs you worse, if you are able to request help to him.
  2. You do not despise the companion who removes worse notes, because to be doctor or nurse he is more than to be exceptional reproducing knowledge in a written examination. It is also empathy, endurance, discipline and capacity of relation with the others. At some future date it can teach many things to you.
  3. You do not keep resentment to other professions, because at some future date you will work elbow with elbow by the benefit of the patients.
  4. You are not punished forcing to you to study when you are exhausted, because a prosperous sanitary race begins by the care of one same one, of the mind, the body and the spirit.
  5. You do not feel failed to have difficulties in the examinations, because probably nobody has taught to you how to do it better and is an expensive learning. It avoids the syndrome of the imposter, I know gentile with same you and little by little learns new techniques with the help of this blog.
  6. Not you obsessions with notes, because they only reflect a part of your abilities. Not you obsessions with a specialty, because the happiness resides in many parts and the personal accomplishment can arrive from unsuspected places.

WHAT OTHER ADVICE YOU WOULD GIVE A COMPANION WHO WANTS TO GET TO BE A GREAT PROFESSIONAL OF THE HEALTH? HE SHARES DOWN IN THE LINE OF COMMENTARIES

Almudena Trinidad
almudena@hshanemd.net

I am otorrinolaring³loga doctor in a hospital of Madrid and Professor Asociada de Medicina in the UAM. I help Medicine students to develop more effective techniques of study to obtain better notes, to remember during more time and to feel like more happy insurances and with its studies.

2 Commentaries
  • Miguel
    Published to 13:42 h, 30 January To respond

    Thanks for the entrance, I have liked much, like the article of €œThe Guardian€.

    I believe that many of the attitudes that we see further on in the residence and have their germ in the faculty, and for that reason it is so important to fight for an educative reform of the degrees. The past year the multi-industry congress of sanitary students was celebrated (Infirmary, Medicine, Pharmacy). It was an incredible experience, and it demonstrated to me that there is potential to take to us between us and to collaborate well, only lacks to foment it.

    Practices common with infirmary, real integration of the faculties, to implement systems of approved/suspended, to introduce professionalism concepts€¦ There are many tools to our disposition. As students, aside from requesting those tools, we can try the empathy. Perhaps that unfortunate commentary that did you by the group of class is not because they do not want changes, but because all we are exhausted of so many examinations and entregables, and the idea to have €œto work€ in the practices more produces oppression.

    Thanks to write!

    • Almudena Trinidad
      Published to 14:20 h, 30 January To respond

      Thank you very much to comment, Miguel! I believe that towards 1996 the first experiences of multi-industry education in countries of English speech began. Immersions of 2 weeks have been used several times throughout a same course, multi-industry practices in visits at home, activities in classrooms, and practices in special hospitable plants. But this requires of specific supervision and trained facilitators.

      I see distant the day in that something therefore becomes in Spain, but the truth is that I do not know if is being made already in some place. The expert British in the subject warn, in any case, of the €œhidden curriculum€: he does not serve much as sharing hours with students of different sanitary races if a real atmosphere of multi-industry collaboration in other scopes of practice does not take place€¦

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