Modern healthcare is designed to contrast poverty with wealth. Most public patients are a vastly different class to us – often uneducated, sometimes immigrant, or non-English speaking. As doctors, we have to daily explain, commiserate and care for people who we could never truly empathize with. By definition, working doctors and nurses are university educated, employed (and therefore probably solvent) and probably more broad-minded than average. Their spare time is spent with their family (who also have the benefits of a regular salary, and are usually educated). If they have no family, perhaps they spend time with their friends, who they met at University, or in their final years of high school. Medical professionals are simply unlikely to know many people personally, who are in the positions of their patients.
When I was first taught this as a student, it seemed profound. I was married, and lived with my educated husband, and spent my spare time with my friends from church (which was located in a comfortable middle class suburb). Today, with kids, my interaction with the outside world is even more limited. My friends are medical, or IT geeks from my husbands work, or members of the same church. I see “kept mamas” at my daughter’s private kindergarten. The only chance I have to meet “normal” people are my kids’ swimming lessons, although infant classes are hardly mainstream.
As a doctor, this trend worsens. No longer is it just that you don’t meet struggling people in your own life. Now you start to develop a contempt for struggling patients. I mean, uneducated people can do really stupid things. After a long shift, there is no energy for the bogan who stabs his mate with a pocket knife so that they can both get codeine from the ED. Empathy begins to dry up. And that poisons your interaction with the other patients you deal with – the little Greek couple surviving on their vegie garden, the guy who cuts his hand opening the security sleeve on stolen CDs, or the mother who takes all 5 kids to ED in the middle of the night because one has a cold.
So at least those doctors working in public hospitals deal with poverty every day. We tend to be compassionate people, but we can’t possibly empathize with people we see who are dealing with poverty every day. Most people in suburban Melbourne have some sort of government financial support, so we can pretend their life isn’t more difficult than anyone else. But poverty and its implications change the way we can look after them. Despite governmental aid, this group is often low in social support, late to present, and have little reserve to cope with the effects of illness.
I don’t have a solution to poverty. I don’t have a solution to my inability to understand people dealing with it. I can’t put myself in their position, and there will always be a chasm between healthcare and those dealing with the reality. I need to remind myself of it regularly, though.
This post was written as part of Blog Action Day, 2008. This blog doesn’t earn any money, but I will be donating to Doctors Without Borders to support their work with the medical needs of the poor of the world.
Hey Scapel,
(not sure what to call you really…)
Love the post and would like to encourage you to submit it for World Vision Australia’s Blog Action Day comp.
I have a few med friends in Melbourne (where I live) who have done placements in lower-social economic areas and poverty is in your face.
best of luck…
@NigePresto: Thanks for the comment, and the link to the competition.
I think that poverty is in your face in most public hospitals. All of the ones I work at service at least some areas of poverty. And the model of public healthcare means that those patients tend to be over-represented, so we deal with them a lot.
That is why the basic disconnect between doctors and patients is such an issue. We simply can’t empathize with these people, in the sense that we can not possibly imagine life in their position.
By the way, my name is Cris Cuthbertson, and you can read more about who I am here