NMSA

Leadership Blog Series – Reflection on the “Fixer” Mentality in Medicine

Welcome to our leadership blog series! This month,  Aubrey Corbett -the Chapter President of the National University of Natural Medicine– discusses how the medical system subjects patients to feeling as if they are “broken” and have to be “fixed”, how this affects the healing process, and the obstacles we have to overcome to move away from this mentality.

Reflections on the “Fixer” Mentality in Medicine

Last term I started a new rotation at a place called the Men’s Residential Center. This is an inpatient drug and alcohol treatment facility where patients, often those with substance use disorders, live for a period of time during their recovery journey. The first day I walked into the  center, I was extremely disoriented. In place of sterile clinic rooms, there are large rooms with TVs and a curtain down the middle that creates a two-room treatment area. In place of a waiting room, there is a large bustling area with men eating food and laughing with one another. There is no fancy lab or private rooms, just one large fluid environment where over fifty men work together to regain their strength during recovery.

I walked in on my first patient visit there to a man sitting on a table with a history of multiple fractures, tattoos from head to toe, and was looking down at the ground anxiously. This patient also had a diagnosis of hepatitis C, and had not seen a physician in over 10 years. I quickly learned that this was not uncommon for the population served at this clinic. These men avoid medical care out of fear of being stigmatized or mistreated, and after hearing some of their stories, I can not blame them.

In fact, one recent systematic review confirms that there are frequent negative attitudes of healthcare professionals towards patients with substance use disorders. It further recognizes that this creates an obstacle to cure for the patient as well as substandard care.1 The patient leaves these encounters feeling un-empowered and more ostracized than when they first walked into the office simply looking for help from another human being. Over 50% of these patients report feeling “out of place in the world”.2

I recall sitting in this visit anxiously searching for something to offer this patient. My mind wandered quickly from how far their hepatitis had progressed, to how to best manage his pain and somehow “fix” his anxiety and all of the hurt that this world has caused him. About ten minutes into the patient’s history and interview, I began to feel helpless recognizing that as much as I could offer him with medicine, there was nothing I could do to take away his painful experiences.

I did some preliminary exams and mentally summarized my findings to present to my attending. When my attending entered, before I could give my medical clinical presentation, he sat down with the patient like an old friend to catch up on last week’s happenings. He asked the patient how his sleep was, whether he was finding community in the program, and genuinely how he was doing. The air in the room immediately calmed and the patient began to discuss his life much more openly. He was suddenly validated that it was okay to experience and talk about hardships.

I learned a crucial thing from this rotation, something that medical school does not teach us. There is more than the biomedical side of medicine, there is a human being in front of us, and we do not always need to fix something. Sometimes with the most underserved populations, it is more about hearing their story, letting them talk about the progress they’ve made from where they were, and connecting on a deeper level. It is likely that these patients have been starved for human connection and compassionate care for a pathological amount of time. We have a golden opportunity to step in and show them that the world is safe again, especially in a historically stressful setting.

While we still offered this patient some supportive treatments, I truly believe that we did more with our words. I debriefed with my attending and mentor about this afterwards and learned that it is okay to sometimes do nothing “medical,” and that it is enough to just build human connection. As medical professionals, it is easy to become numb to the emotional body. It is so much easier to just throw St. John’s Wort or an SSRI on the depression than to sit with the person in front of you and hear about their journey. However, the more numb we continue to be in this realm, the more numb we allow our patients to be in embodying their struggles. By giving space for more human connection in a patient encounter, we open the door to healing.

Author: Aubrey Corbett

CHAPTER PRESIDENT, NATIONAL UNIVERSITY OF NATURAL MEDICINE

Aubrey is a fourth year ND student from the coast of South Jersey. She graduated with her bachelor’s in Biology from Richard Stockton University in 2014. She has a special interest in finding ways to bring nutrition and other naturopathic modalities to underserved populations at community health centers. In addition, she is employed as an emergency department scribe, teaches nutrition at a local cooking class, and is the western sciences teacher for a massage school. Additionally, Aubrey is currently the NMSA Public Policy fellow, which has allowed her to focus on expanding education about naturopathic medicine in New Jersey through assistance in development of the NJANP website. Outside of medicine, she enjoys surfing, hiking, rock climbing, camping, and essentially any activity near a large body of water.

References

  1. van Boekel L, Brouwers E, van Weeghel J, Garretsen H. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug Alcohol Depend. 2013;131(1-2):23-35. doi:10.1016/j.drugalcdep.2013.02.018
  2. Kulesza M, Watkins K, Ober A, Osilla K, Ewing B. Internalized stigma as an independent risk factor for substance use problems among primary care patients: Rationale and preliminary support. Drug Alcohol Depend. 2017;180:52-55. doi:10.1016/j.drugalcdep.2017.08.002

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