Unlearning and dying

Something funny happens to doctors, and, I imagine anyone else who changes from being a layperson into something other – nurse, physio, engineer, electrician.

The thing about doctors is that we still occupy such a position of authority within the whole health and social care world. Don’t get me wrong – I don’t want people to stop listening to me, or to challenge everything I say, it is just, we all need to keep a sense of perspective.

I think it is the perspective that diminishes through the transition from apprentice to journeyman then master.

I am most aware of this when I see people – patients who are reaching the end of their lives.

I think when someone is dying, we instinctively know. This is not in relation to sudden, tragic, unanticipated events, but the fading away from old age that if we are lucky, we get to experience in the company of our family, friends and people we love.

Yet – the evidence suggests that when a doctor approaches a person as a patient, their judgment or perhaps insight into the proximity of the other to death is skewed.

People aren’t perhaps aware, but, there are individuals in hospital and living at home today in Britain who are receiving treatments, investigations and procedures that will neither improve their quality nor length of life.

In health and social care, we sub-divide the end of life into three somewhat arbitrary phases – final year of life, last three months and final days. I guess this helps us contextualise.

People in the final months of life are still able to live happy, productive lives, although when the final deterioration comes, when the rate of change speeds-up, people usually prefer to spend time with those they love rather than those in healthcare.

The thing about the unlearning is that when I talk with new doctors, those who have just qualified from medical school – they are very often able to see the futility of treatments foisted on their patients, they are, unfortunately, frequently, still in such a position of experiential and hierarchical separation from those making the decisions – the bosses aka consultants, that they are unable to express their concerns or doubts.

The consultants likely forget what it was like to be a newly qualified doctor, the chasm that can sometimes exist between what you and they think. Let alone the distance that probably exists between them and their patients.

We need to unlearn some of what we have taken-on, those of us who have moved through the profession and we need to support those who have just arrived to hold-on to their beginner’s mind, their curiosity, and, ability to see the world from novelty.

Let us unlearn the textbook, pathways and processes of care and return to that place that is at the core of all humanity.