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Every Day as a Doctor I Ask Myself If a Puppy Would Do More for Patients Than I Can

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Nahvi is an emergency medicine physician and the author of Code Gray: Death, Life, and Uncertainty in the ER.  

I became a doctor because I wanted to help people. Like “supporting the community” and “doing what’s right,” the idea of “helping people” can be so vague that it borders on meaningless. And so, having entered medicine with good intentions but without specifics about whom I wanted to help or how I would go about doing it, I would soon learn just how hard it was to truly help anyone at all.

The truth is that the idea of a sick person coming to see a doctor, being diagnosed and treated, and later leaving cured and satisfied is somewhat quaint. These days, patients often arrive with chronic problems that we might be able to patch up, but we cannot cure. We can make sure our patients suffering from dementia take their medications on time, for example, but there is little we can do to treat their underlying brain disease. We can lower our diabetic patients’ blood sugars when they get too high, but we have nothing to actually cure their diabetes itself. And when our patients with end-stage cancer arrive seeking relief from their cancer pain, we know that even our best treatments will do nothing to stop the progression of their real problem.

And so, early on in my career—frustrated by our collective inability to help our patients to the degree that I wished we could—I began playing a game I call “Medical Degree versus Puppy Dog.”

After each patient I saw, I would ask myself: Would this patient’s problem be better handled by myself, with a decade of rigorous medical training and board certification in emergency medicine, or by a yellow Labrador with a wagging tail?

I kept a written tally. “Medical Degree” would mostly win—but that was little reassurance. That it was a close competition at all was somewhat disturbing. Furthermore, that I would occasionally wrap up a shift and realize that “Medical Degree” had lost to “Cute Puppy” was a more profound statement of modern American medicine than anything I have ever read in any newspaper’s op-ed page.

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The game is effectively this: Many of our patients are already well aware of the limits of modern medicine. The majority of those suffering from chronic illness have lived with their problem for years and know their situation better than their doctors do. They appreciate our treatments, of course, but ultimately what they are really looking for is to simply feel better. These people want comfort and reassurance. They want to feel cared for.

Dogs are excellent at this. They lie on our laps and express their affection. They are deeply concerned with what we are feeling. They allow us to tell our stories and are never in a rush to leave our side. So while they provide no breakthroughs and certainly administer no pharmaceuticals, they nevertheless provide a terrific comfort.

What dogs offer so readily, of course, is precisely what modern American physicians do not. Every year, our system equips us with more medicines to prescribe our patients yet less opportunity to sit down beside them and explain how they should be used. Each new administrative initiative brings us more tasks to complete and less time with which to complete them. Staffing cuts and bureaucratic demands resulting from corporate control of medicine force us to sprint through our days to accomplish the bare minimum of keeping our patients healthy, often leaving us unable to perform the critical task of simply slowing down to listen to them. As a result, we can find ourselves in the curious position of having saved our patients’ lives, only to realize that they remain generally frustrated with their experience. More curiously, we understand that they are not necessarily wrong to feel this way.

And so, having found myself on the losing side of an end-of-shift tally to a puppy, I have come to appreciate that if I was ever going to make good on my original intention to “help people,” it would not be by simply applying the skills I learned in medical school. Providing the correct medical treatments— even diligently saving lives—is not enough.

We need to do much more. We need to wrestle back control of our healthcare system from the corporate control that has led to so many of our runaway problems. We need to institute safe staffing mandates so that our hospitals have more doctors and nurses, allowing us to slow down and sit at our patients’ bedsides once again. We need an end to for-profit medicine that treats patients like bureaucratic boxes waiting to be checked off, and we need universal healthcare that simply puts patients first once more. If we are going to truly find a way to “help people,” we’re going to make our healthcare system a bit less like the sterile bureaucratic machine that it has become, and a bit more like my dog.

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