nudge

What makes me feel less despondent and sad about witnessing so many things, even with just one year as medical student, is learning that my place as a physician will be not necessarily to fix (although that is gratifying!), but to nudge patients in the right direction.  There is so much momentum behind each situation that presents at a moment of crisis to the emergency room or clinic visit - something pushed that patient to come there.

No, you cannot fix an abusive relationship in 5 minutes.  You cannot fix depression or anxiety, joblessness or disability, or the perfect storm of environment and poverty that led someone to obesity, diabetes, poor vision, and nerve damage.  However, we are in a place to nudge patients in the right direction.

I would be horribly depressed if the only tools in my arsenal were pharmaceutical.  However, there are dietary changes, exercise, lifestyle changes, alcoholics anonymous support groups, technology apps, books, physical therapy, and a host of other ways to nudge people's help in the right direction.

When I stop looking at the task of the medical professional as being a "fixer" and start thinking about myself as a guide, a teacher, and a healer - someone to accompany someone throughout their disease - then I understand all of these things as being achievable.  Sometimes patients just want to unload their fears and feelings in the context of the confidentiality of physician-patient.

Many years ago, I had the privilege to work as assistant chaplain.  What I found most mind-blowing about the experience is that what was wanted of me was simply to show up - what my mentor called the "ministry of presence."  I found it very bizarre that I wasn't expected to produce anything, but simply to be present.

I think in clinical medicine, understanding that my job is only partially to help manage disease, but in many ways to simply be present - to accompany a patient in their disease, whether or not it is fixable, and let them know they are not alone.

I think about communities, about influence points, about problems and how I would attempt to solve them: media, flyers, community education, technology, online tools, community and volunteer groups, environmental changes, art, movies, etc.

I would want to be embedded in my community to know who the influencers are, what the tipping points are, what places nudging would have the greatest effect.

I'm not sure how that matches with mathematical biology, aerospace and preventive medicine, and/or allergy and immunology.  But I can see what I am passionate about is patient education, disease prevention, and creative ways to intervene upstream of illness and disease.  I don't want to be so narrowly focused on one set of tools that I am blinded to the bigger picture or more effective ways of dealing with problems.

The kinds of project(s) that I want to work on during my clinical training years I envision as being a combination of technology and patient education.  I think after I get back to more full-time research that I will work on a more basic mathematical biology problem, but at this time, it makes sense to me to work on topics that are less time-intensive.

I think that internal medicine was a good choice because I want to see illnesses evolve with time, because I want to understand the whole system, and because it puts me in the right place to understand the different points of influence to change systems.