Diabetes and Lipids Rotation Week 1: Finding Compassion
Last week I started my internal medicine subspecialty. One thing you will
learn about a rotation schedule is that it is constantly changing. Originally I
was supposed to be in pain management, then it switched to renal transplant, and
now it is endocrinology. This month I am in a subdivision of endocrinology that
specifically sees complex diabetes and hyperlipidemia. We only accept patients
with an A1C level (3 month average of glucose) over 9 and who are on insulin.
The majority of this patient population has type 2 diabetes mellitus. The typical patient we see is severely obese, has terrible eating
habits and is not compliant with their medication. The most concerning issue
is the medication noncompliance. They may take their insulin at sporadic times
without checking their blood sugars which can lead to serious effects like
hypoglycemia. The first couple of days of this rotation, I noticed a strong
annoyance/dislike of these patients building inside of me. I was bothered by
the fact that these people are not motivated, continue to make the same bad
choices despite their complications, and come to the "specialist" office
expecting things to change. It is ironic to think that one of the most complex
diseases affect the laziest people. Now you see what was happening within me? I had some soul searching to do.
On the 3rd day, I asked my preceptor how
she was able to have compassion for these patients day in and day out. She told
me about a lecture she once attended where the topic was over sympathy, empathy
and compassion. She went on to tell me that sympathy is feeling sorry for
someone but without respect. Empathy was relating with the patient about
certain feelings, emotions life experiences but still it is without respecting
the patient. Compassion is the ability to care for a patient without passing
judgment and thus giving them the respect they deserve. First off, I was
allowing the patients' choices to affect me when in reality they only affect the
patient. Secondly, I was clearly judging the patient's cyclical behavior which
resulted in annoyance/dislike. My eyes were opened to my own lack of
compassion. It was a humbling experience to remember what I am here for. It is
not my job to fix the patient who spirals towards obesity and diabetes. It is
my job to walk alongside them as they figure out what they want. We are here to
help at all times, not just when the patient is fully motivated to change.
It is very easy to become cynical about the obesity, diabetes and
hyperlipidemia that plagues our patients. We have probably heard every excuse
under the sun about why they are the way they are and inwardly we know they just
don't want to change. If true compassion is caring for the patient without
passing judgment, we have a long way to go. I believe all of my patients want
to change but there is so much that inhibits this from happening. Who am I to
count these inhibitions against them? They come to me because a "clinician" is
expected to show compassion. Practicing medicine requires the knowledge of self
in order to share the knowledge of life. Knowing our inward reaction to the
patient will foster an environment of compassion.