Also Human: The Inner Lives of Doctors

Book Title: Also Human: The Inner Lives of Doctors

Book Author: Caroline Elton

Publication Information: New York: Basic Books; Hachette Book Group, 2018, 311 pp., hardcover, $30

Physicians are also human beings!

You may think, “Well that’s a ‘duh’ statement!” Yet, is it also intuitive that physicians-in-training must dehumanize themselves in order to successfully navigate laborious and numerous years of training? Does the compartmentalization of a physician-in-training’s humanity actually facilitate success, or does it blindly enable unwellness, mental illness, cold-heartedness, and in the absolutely worst-case scenarios, lead to suicide? Beyond the individual physician, what are the consequences of such desensitization for our entire health care system? And finally, has that system been complicit in this dehumanization process?

Indeed, any of you who started your first day of medical school with the welcoming pronouncement, “Look to your left and look to your right—one of the three of you will not graduate,” might share in the belief that the intentional pruning of medical students has been a theme of institutional pride. Ironically, however, you are likely to also have heard the exalted Hippocratic Oath; and when you did, you most likely fully understood it as a physician to patient oath, not as a contract of the medical education system to first do no harm to you, the physician in training.

In Also Human—The Inner Lives of Doctors, Caroline Elton, a vocational psychologist with over 20 years of experience working with medical students, residents, and practicing physicians, addresses these concerns with multiple relevant anecdotes as well as a developing body of research in the field. Since 2008 she has worked in the United Kingdom’s National Health Service to develop and run the “Careers Unit—a service for all trainee doctors in the seventy-plus hospitals across London” (p 4). In this book, Elton uses her vast and unique experience to expose system failures and shortcomings, and ultimately direct a humanistic path forward.

Elton explores themes of institutionalized dehumanization such as the one that classically occurs as new student doctors meet their first patient, a cadaver. This may be perceived as the initial step in “positioning (medical students) as ‘other’ than their patients” (p 129). This process is largely unconscious, and it buffers students from the emotional anxieties of mortality. Objectivity becomes a defense mechanism, imperceptibly reinforcing the split between “the first patient” as purely mortal, and the student doctor as MD, “Medical Deity.”

Advance forward through medical school graduation to a new doctor’s first day. In the United Kingdom this occurs on the first Wednesday in August. Despite 4 years of intense medical education, Elton describes a UK General Medical Council report that found that new physicians “felt unprepared, particularly for step-change in responsibility, workload, degree of multi-tasking and understanding where to go for help” (p 16).1 In the United States, a similar situation has been termed the “July Effect,” where significant negative changes in mortality, efficiency, and fatal medical errors occur in hospitals with medical residents.^2,3

After laying the framework of a system that traditionally emphasizes objectivity at the expense of humanity, Elton depicts various scenarios that further stress the well-being of young physicians. What happens when doctors become patients? Why do demographics of specialists differ so greatly from those of medical schools? Why is it that the lowest-performing medical school graduates often get matched to graduate medical training in locations and settings that are less equipped to support them? How does medical education prepare physicians to deal with their own sexuality when they perform intimate patient exams? Elton skillfully addresses these questions with real-life cases while changing names and other identifying factors to protect client confidentiality.

To deal with stressors at the individual physician level, Elton outlines how multiple defense mechanisms kick in “as a way of protecting (oneself) from emotional disintegration in the face of overwhelming psychological stress” (p 56). These defenses arise spontaneously like an immune response stimulated as doctors face dying, death, sorrow, and suffering. Unlike specific antibodies however, defenses such as avoidance, intellectualization, suppression, and repression are nuanced and metaphorical. Additionally, and of great significance, developing resilience in this setting is contextual, complex, dynamic, and takes time.

Fortunately, Elton describes evolving initiatives and institutional changes to help address most of the issues that she unpacks, leaving substantial hope for the future. Not only an enlightening and inspiring resource for wounded healers at any level of training or practice, this book serves as a loud beacon for necessary self-reflection and change throughout our system of medical education. This book will permanently alter your perception of medical education and how it impacts the humanity of young physicians—and you’ll be immensely grateful for that!