“Warm Nights” by Danielle Couture, MD
Launching The Penndulum, our goal was to give physicians a venue to speak their truths.
Don’t doctors always tell the truth? We don’t. While it’s rare for physicians to purposely mislead people with lies of commission, doctors constantly bend and shape narratives, leaving out information with lies of omission.
We leave out clinical information. We never cite “no open hospital beds” as a reason to discharge a patient. It wouldn’t help if we get sued. In a perpetual time-crunch, we document a fraction of the endless details patients report, picking the best facts to justify our assessments and plans.
We leave out personal information. We lie about our anger, fear, despair, and disgust since it’s not popular with friends, family, or patients. We never tell patients when we feel delirious from sleep deprivation. As trainees, we often stay quiet when our supervisors show poor judgment or act unprofessionally because medicine is hierarchical and we’re indebted, exhausted, and afraid.
The stories most commonly told by doctors in the medical record, conversations with colleagues, and even lectures to students are not truth telling personal memoirs. They are narratives meant to ease the tension between conflicting bureaucracies (state medical boards, the justice system, insurance companies, hospitals) that ultimately govern modern medical practice. These political stories carry some truths but cover others. They function to ease systemic anxieties rather than directly convey information. They keep the peace between institutions of power. We tell the tales of the system instead of our own, and in the process we can lose our authenticity and humanity.
Inauthenticity can kill. Doctors bear the weight of untold countless dark experiences in silence. We feel compelled to tell tiny lies throughout the day ranging from “I’m fine,” when we’re not to, “I agree with Dr. W’s assessment and plan” when we don’t. It takes a toll. Doctors in training are three to four times more likely to be depressed than their peers. By becoming a doctor, a woman more than doubles her chances of dying by suicide.
If lies and alienation can kill, maybe truth can save lives. The truth is scary, hurtful, and risky. Yet without the truth there can be no hope for change. We must speak freely about the challenges we face personally and those inherent to training as physicians in a broken healthcare system. From this perspective of honesty, we can create new narratives that serve not just institutions of power but also the providers, the patients, and the relationships amongst them that serve as the ultimate basis of clinical practice.
Truth-telling has been the spirit and purpose of The Penndulum since its conception and is at the heart of this issue’s theme, truth and lies in medicine. We hope you will find it compelling, heart-felt, and concerning, because it is all of these things.
Your editors in chief,
Lisa Jacobs, Danielle Couture, and Behdad Bozorgnia