28 May 2013

Non-judgmental regard

When I first met the patient, two armed corrections officers with serious expressions were standing at his bedside. I wondered why he was in jail. I'm sure the other members of my medical team were curious as well. But we all knew that it would be highly unprofessional for us to ask. After all, what he stood accused of should have had no bearing on how we treated him. This attitude exemplified "non-judgmental regard," a precept of medical practice that I've been grappling with for years.

From a post of mine in August 2011:
...[I find] the most extraordinary and difficult tenet of modern medical ethics [to be] "non-judgmental regard." Physicians are supposed to take patients exactly as they are, without judging or discriminating. In principle, then, the armed robber and the man he injured, in neighboring beds in the ER, are provided the same degree of care. The morbidly obese smoker with a heart attack should be treated with the same earnestness as the thin one. Judgments of worth or character are independent of treatment...

Because I've decided to become a medical student, I have to make medicine's ethical precepts my own. But I have a difficult time with shedding judgment. I don't treat people equally in my own life. I have friends, acquaintances, and enemies, and I care about some of them more than others. In clinic, some patients' stories touch me more than others'. One patient had developed a crippling Parkinsonian tremor, probably secondary to his addiction to meth that he had tried and failed to kick. His circumstances were wrenching and I especially wanted to help this man. My next patient, a woman with conjunctivitis who lambasted me for fumbling at first with the blood pressure cuff, was less inspiring. Some patients are especially kind to me in a way that I particularly want to reciprocate...

I couldn't shake my curiosity about the patient, and ultimately did discover why he was in jail. He was a convicted murderer.

My professional ethics dictated that this revelation shouldn't matter to me. But I felt conflicted. After all, whenever someone is assigned to me or my team as a patient, I care about them. I smile at them when I see them. I stop by their room, sometimes several times a day, to say hello and to see how they're doing, to see how I might help. And I sincerely want to see them become healed. But, for a murderer? On a rotation so busy that I felt I was neglecting my friends and family, could I justify lavishing this kind of endearment upon a murderer?

I reflected on the ideals of our legal system, which stipulates that every person deserves legal representation. I reflected on the ideals of our penal system, which hopes to reform prisoners into moral and functioning members of society. I also reflected on the ideals of religion, which strives to improve all men's souls. Should medicine, the art of healing, be any less noble and discriminate among who it cares for?

What has kept me going throughout medical school, and what compels me to set my alarm for 4 AM some days, is an idea. It's a belief that medicine is a worthy calling, a profession that can improve others and improve myself. This medical profession behooves me to care for even the most depraved among us, no matter how vexing that might feel. We must respond to hate with love. We must strive to relieve suffering and to do no harm.

If you do read my full post from 2011, you'll see how ambivalent I was about treating all patients the same. My thoughts have since shifted. I more firmly believe now that non-judgmental regard is an aspiration worth pursuing.