Family and friends frequently ask medical trainees for their medical advice. Naturally, our recommendations are not based on medical experience, but rather our shared humanity.
A common, much parodied social trope is that of a layperson asking a health professional for non-specific medical advice in a casual non-professional setting. As per population level data, a health care professional (regardless of their interest or specialization in dermatology) will be asked to distinguish between a benign back mole and melanoma at least twice in their careers.
The provision of unqualified advice, solicited or unsolicited, is a gross contravention of the medical precept of primum non nocere (first, to do no harm). However, refusal of acknowledgment of the anxieties of another seems akin to denying one’s humanity. After all, empathy and being human comes from an ability to share, relate to, and engage with the emotions and experiences of another.
As a medical student aspiring to be a psychiatrist, I have often find myself ruminating on this topic of giving medical advice. The limitations of the dissonant options of either providing unqualified advice or refusing to acknowledge the interlocutors has always bothered me. A recent instance of just such an interaction, one I share in this essay, has markedly changed and informed my views on this topic.
Sympathetic of the pressures on my time as a busy medical student, my friends from yester-years have taken to scheduling phone conversations in advance. The most recent instance of this read more like an emotive plea than a request for a future engagement. “Can we talk? I have bad news.”
The possibility of anything “bad” has, naturally, always been a trigger of anxiety for me. Learning of something bad is akin to carrying a burden. There is an upper threshold of negativity that one can carry at any time. This has always been my understanding of how some deal with trauma better than others; some are built to bear more than others. Like most, I carry my fair share. However, for a friend one always needs to take on more—a feather or even a boulder.
Over the phone, my friend synthesized lengths of times into a rapid succession of breathless sentences. “My brother just graduated. He had been looking for a job for the past month. It seemed natural for him to spend more time by himself, looking at online postings. Over the weekend, he broke down. He told my parents that his computer spoke to him. It warned him that someone was out to get us. He is now an in-patient; we’ve been told he had a psychotic breakdown. My uncle also has schizophrenia. What will happen to my brother?” His tone, save for a note of despondency at the end, was devoid of any affect. Almost as if the cloud that hung over his brother was growing, feeding on angst and anxiety, and engulfing everyone in its ambit in a self-perpetuating gloom.
As per the Hippocratic tradition, the ideal physician is someone who can prevent and predict. My friend knows, as I do, that I am not a physician yet. I have, in fact, yet to enter clinical training. I cannot, and am not qualified to predict.
With respect to his brother, all I could offer him was a referral to resources. Journals, with research papers that did their best to predict through statistical extrapolation. I could not tell him whether one of those numbers foretold the rest of his brother’s story. It was too late to prevent. There was no point in counseling the sequencing of genes, it didn’t matter in the immediate term what viral infection had inflicted him in childhood. The initial course of his condition was already been charted. At this point, it is now a disease where clinical practice guidelines offer treatments that will help control the symptoms of the disease. It is not a hopeless situation, though my friend may perceive it as such.
However, in the course of our conversation, consciously or subconsciously, I came to realize that there was a therapy here, but far from my ability to understand the appropriate treatment standard for a new diagnosis of schizophrenia at my level of training as a medical student. A purpose was served. My patient, the individual whose health I could speak to, was not his brother, but my friend.
I felt instinctively that my task was to provide an age-old treatment; the succor of dialogue with someone who cares, of simple human interaction. The complete presence of another human being, social support; something otherwise unavailable to us because of our contemporary distraction and disconnection from one another. My attentiveness, willingness to be an active listener was serving as a salve.
I sought out his concerns, considered them, and made reasoned suggestions. I tried to imagine myself in his circumstance —how I would act and proceed if I were in his shoes to ensure the best outcome for those I cared about and myself. That is all he really asked for. We ended our conversation, promising to reach out to one another with any new developments. He remarked at the end that he was optimistic; there was room for hope when problems could be given names and then solved.
In all earnestness, I should be more thankful for the dialogue than my friend should. While I am working towards being more informed and knowledgeable and do aim to qualify to be able to diagnose and prognose, I cannot forget about the most important skill of all—that of being able to engender hope in another through the simple salve of human connection. To assist someone in seeing a positive narrative and being an active agent, rather than a passive witness. This skill is one that I can only acquire by listening to, and speaking to, the sorrows and joys of those around me. By staying true to the bond of being human—by attempting to be a brother to my fellow humans. For my friend, his brother, and to future patients, I hope to be present for anyone who would like to talk, engage and interact.