Medical Practice

Traumatic De-Idealisation- A Tale of the Gradual Loss of Faith in the Profession

Author: Dr Deepthi N.S

Imagine a 36 year old ENT surgeon, Mr Z working in India. He is the ‘young dynamic surgeon’ that his peers refer to him as. He works full time at a private hospital and part time in his clinic in the evenings. He has finally started getting a good and steady flow of patients after slogging his way through MBBS, Residency, Fellowship and workshops to acquire the skills that he possesses today and can confidently execute on his trusting patients. He has a loving family, supportive management at his hospital and a stable income. Sounds perfect doesn’t it.

Mr Z wakes up on a Monday morning, he’s having a cup of coffee when his phone chimes once. It chimes in another time and this goes on for a few seconds indicating a flood of notifications. “This has never happened before”, he thinks to himself. He picks up his phone to see a social media post where he’s been tagged. It’s by his patient lost to follow up from quite a few months ago. The post read “My surgery performed by Mr Z didn’t work, my symptoms persisted and I later sought a second opinion. The new surgeon has now operated on me and I’m doing great post-surgery. I’m thankful to the second surgeon who gave me insight on the shortcomings with my initial treatment and saved my life. Please do not trust Mr Z and this hospital as they’ve robbed me of my hard earned money and well-being”.

To anyone reading this would think, isn’t it a happy ending for the patient? Mr Z deserves it, he should’ve known better.

Well I beg to differ. This surgeon has been wronged in several ways and let me tell you why. Surgery is not a linear straight up two plus two equals four. There are diverse approaches in treatment leading to the same outcome. Surgery is not the destination, post-operative follow up is equally decisive in assuring a full recovery. With a patient lost to follow up (not blaming the patient here as reasons are often less subjective) the surgeon straightaway loses his battle.

Can we now talk about surgical mishaps. Let’s say Mr Z did make an error in judgement, this was in all probability done for no personal gains or ulterior motives. We have systems in check for this and no amount of wealth or influence can save you if found guilty. Also a well-trained surgeon (includes mental and emotional hardwiring too), even if impecunious would never resort to harm his/her patients. Errors in judgement happen very rarely in medicine thanks to planning and team effort pre-operatively, intra and post-operatively with often a multidisciplinary team effort if the case so demands. If machines are allowed a margin of error, then how are humans any better?

The second surgeon played dirty, in medicine we follow a ‘bro-code’ and we do not defame our colleagues behind their backs! It doesn’t end well for anyone other than adding fuel to the fire. Like previously mentioned most surgical treatments have diverse approaches and if the first fails you naturally opt for the second. The second surgeon knows that he wasn’t a better surgeon, it’s only because he was at a better timeline on the patient’s treatment journey. The first surgeon was completely capable of making the second treatment option work for the patient, had the patient been on regular follow up.

The surgeon doesn’t take all your money. He or she only receives a meagre surgical cut and the rest goes for various other expenditures like pharmacy, labs, room rent, OT charges etc…, to name a few.

But in spite all these justifications, Mr Z staring at his phone having faced his first professional blow rethinks his entire career. The same colleagues who praised him are now taking sides, name calling and his story makes way into tea time debates. “The ideal life I thought I could lead if I did everything right is gone”, Mr Z thinks to himself. He finishes his coffee, picks up his phone and leaves for work. He has several procedures lined up for today and he cannot afford to back out on his patients.

Out of all the things that went wrong with Mr Z, what broke him was probably his colleague’s below the belt move. One of his own, it’s an indescribable feeling. One mixed with shock, loss of faith and extreme depression. The defamation post was only the nail in the coffin.   

Give two more blows like this and it becomes a classic case of traumatic de-idealisation a term that doesn’t exist but if we can have traumatic ear perforations then why not this?

The so called ideal of having a trusting clientele and supportive workforce doesn’t exist and it breaks through into your world slowly but surely. Added to this are several pitfalls within the system and we have what this article is about- gradual loss of faith in the profession.

Does Mr Z have a happy ending? Probably not. We have too many wounded doctors quietly going about with their jobs, some even ending it all. With forums such as these we intend to hope for a happy ending so please take off your rose tinted glasses of idealism and practice in good faith. The sooner the better so that we don’t lose another Mr Z ever again!

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