Interview at the Col·legi Oficial de Metges of Barcelona: “Vocation is what allows you to protect your patients”
Dr. Salvador Esquena: “Vocation is what allows you to protect your patients”
It’s well known that medicine is a vocation. However, the work and personal circumstances surrounding physicians can cause this vocation to take a backseat and lead to behaviors that can negatively affect patients. This is attested by Dr. Salvador Esquena in his first book, In the Skin of the Patient (ARA Books). His years practicing as an oncologic surgeon have allowed him to
Why did you decide to write In the Skin of the Patient?
La idea de fer el llibre va sortir de la necessitat de fer una autocrítica, després d’alguns anys exercint i de veure algunes actituds i conductes que hauríem de millorar.
What criticism have you received from your colleagues?
Initially, they were surprised and told me it was a brave book because doctors are sometimes intolerant of self-criticism. However, the reviews from doctors who have read it, not just friends, are positive and believe this was a necessary reflection. So far, I haven’t found anyone who has directly attacked me for what I’ve written.
Why did you decide to become a doctor?
Medicine is very vocational, and the common denominator among people who want to dedicate themselves to it is that sense of caring for others. There’s a history of doctors in my family, but it’s probably the vocation to help that drives the vast majority of students to study medicine and want to become doctors.
In the book, you describe different types of doctors, such as the dehumanized or the burned-out type. How does a patient cope with encountering such a professional?
In addition to being self-critical, the book also aims to explain to patients the circumstances of medicine and why they may encounter a doctor who treats them with terrible coldness or with a highly undesirable cynicism. However, as many reasons as there may be that might explain why a doctor might be very dehumanized or someone who barely even looks at you or shows any interest in your case, the reflection is that this cannot be the case. Doctors cannot adopt these attitudes.
Are you optimistic and do you believe that future generations of doctors will be more humane or less burned out?
From the perspective of a burned-out doctor, I’m not overly optimistic. No government of any political persuasion has been the least bit concerned about the exponential increase in cases of burned-out doctors. I’d like to be optimistic, but I’m a realist and I don’t know if there will be any improvement in this regard. From the perspective of a dehumanized doctor, I have two feelings. On the one hand, I think that most students who want to study medicine have that sense of caring for others and, therefore, have a more developed human and empathetic side. On the other hand, I think that the selection of students for the degree is governed exclusively by grades and knowledge exams, and that a person with a very important ability to study and pass exams probably isn’t assessed for this human, empathetic, and humanistic side. This is very important in medicine and should be fostered throughout the degree.
In addition to raising awareness among medical students, do we also need to foster communication skills among professionals?
Physicians themselves must be aware that it’s not enough to be a great technician, a great diagnostician, or a wonderful surgeon; this human aspect is part of the medical practice and is essential. If we have the resources, that’s great, but there are many people who lack our empathy and communication skills. We must be aware of this and do our best to work on them because otherwise, our medical practice isn’t complete, and the patient suffers from it.
In the book, you also talk about the introduction of new technologies. How do you think they influence their relationship with the patient?
New technologies have helped us a lot in streamlining data, but they can also lead to the loss of classic aspects of medicine, such as listening to the patient, looking them in the eye, examining them, etc. Although we have a series of technologies at our disposal that we never dreamed of, they can cause our relationship with the patient to become even more dehumanized.
And what about the patient’s role?
There’s a tremendous amount of information online. Patients get their information and come to the office with a stack of Google Sheets, thinking they practically know more than you do. We must try to handle this situation as tactfully as possible because, depending on the patient’s attitude, doctors can feel reprimanded. We often don’t take well when someone comes to us and tells us they’ve read a lot about their condition. However, this doesn’t mean they know anything, because information is one thing and knowledge is another, and an excess of information on a topic you don’t understand ends up causing misinformation. We need to have enough patience to explain everything they’ve seen on the Internet and tell them exactly what is real and what isn’t. This, of course, requires patience and time, and this is precisely what we lack in our practices and what we have been advocating for decades.
Doctors also have a narcissistic streak…
Perhaps not all of us, but many doctors have a narcissistic streak. I’m the first to be self-critical in that regard. Narcissism, in small doses, I don’t think is negative at all. We doctors do meaningful work that is sometimes very difficult, so when things go well, you want recognition for your work. The problem comes when narcissism becomes pathological, and you encounter selfish individuals who believe they are the center of the universe. From the patient’s perspective, a runaway narcissist prioritizes their needs over those of the patient and turns the patient into an instrument for self-promotion.
At the end of the book, you explain that doctors learn about their reality when they become patients. Do we have to go to this point to change things?
There should be other ways. To write the chapter on the sick doctor, I spoke with many doctors, and all of them were very good doctors, very concerned about their patients. They all told me that they have changed some attitudes. They have seen medicine from a perspective they’d never seen before. We shouldn’t get sick to put ourselves in the patient’s role and realize that something isn’t working or that some attitude we should change or correct first. This is one of the most important reflections.
What advice would you give a young doctor to avoid falling into one of the profiles you describe?
I’d love to give wise advice to a young doctor, but theoretically, a doctor’s vocation is the driving force behind how we function. It’s a vocation that can be undermined over the years by many factors, but if you maintain it and withstand the attacks you may receive, this vocation will likely always allow you to protect your patients.
