If Marcus Aurelius Were A Doctor

When a man kisses his child, said Epictetus, he should whisper to himself, “To-morrow perchance thou wilt die.”- But those are words of bad omen.- “No word is a word of bad omen,” said Epictetus, “which expresses any work of nature; or if it is so, it is also a word of bad omen to speak of the ears of corn being reaped.”

The above is a meditation by Marcus Aurelius.  It’s not the most well known, but when I first read Meditations, this one really stayed with me.

Accepting that life is finite, although jarring is empowering because it allows you to focus your finite time on aspects which you do have under your control.

I’ve found that a lot of doctors cannot accept the fundamental truth that they cannot predict or control what will happen to their patient.  When a patient walks out of your room he or she may die.  It happens all the time and most often it’s the patients that you least suspect that get unwell.

What I find interesting is that a lot of doctors try to counter the inevitability of their patients dying by becoming emotionally involved.  I have seen some of my colleagues cry and go into depression because they get so involved.

Patients themselves may want their doctor to be more emotionally invested in them.  They may prefer and consider doctors who are more emotional to be the better doctor.  But just because they may prefer something doesn’t make it correct.

I find that a lot of people in the general population would prefer to not take responsibility for their health and outcomes in life.  If their doctor becomes invested in them, they feel that they are able to give the responsibility of their health over to their doctor.  This is patient disempowerment rather than empowerment in my opinion.

In 90% of cases a patient should not expect to give over complete responsibility of their health over to their doctor.  A lot of patients have actually tried and failed to sue their doctor because of this false expectation.  When a mother sees a GP about their baby and is told that the baby has a viral infection, but if things deteriorate to seek medical attention – we are telling that mother that nothing is certain in life and actually, there is a chance that this could turn out to be meningitis.  A doctor can only go by the clinical picture in front of them and come to a logical clinical decision.  It is up to the mother to act responsibly and do something if the child becomes more unwell.

Another sign of how dependant patients become / how unrealistic their expectations are is when patients complain about seeing several different doctors before getting to the correct diagnosis.  Patients don’t realise that if this is the case, it’s extremely likely that the way the patient presented was atypical as is evident by several different doctors coming to an incorrect conclusion.

Doctors should not become emotionally involved and accept full responsibility for their patients health.  Sure, we can empathise with our patients.  But what we mean by empathy is that we get where the patient is coming from, we try to understand the patients life circumstances and try to formulate a management plan which the patient can tolerate and live with.  Empathy does not mean becoming emotionally invested.  This is actually a very quick way to allow unknown biases to sway your medical judgement and provide poor care.

“All men are made one for another: either then teach them better or bear with them.”

I wonder what Marcus Aurelius would think about becoming emotionally attached and accepting full responsibility for their patients health.  I think the above quote sums up the correct attitude you should have as a doctor.  If the patient listens you can teach them about a healthy lifestyle, how to manage their medical problems as best as they can and so on.  (And always document what you have said!)

If patients do not like what I can do for them with the tools that I have available at my disposable then it is none of my concern.

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