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If I am not for me, then who is for me?

If I am just for me, then who am I?

And if not now, then when?

-Jewish koan

I watched the film, The English Surgeon last week, 3 times.

The film follows brain surgeon Dr. Henry Marsh as he openly confronts the dilemmas of the doctor patient relationship on his latest mission to the Ukraine. He explores questions like what is it like to have God like surgical powers, yet to struggle against your own humanity? What is it like to try and save a life, and yet to fail? Dr. Marsh is one of London’s foremost brain surgeons, but despite being a leader in his field he stills rides an old pushbike to work and worries tremendously about the damage he can inflict on his patients. As he states, “when push comes to shove we can afford to lose an arm or a leg, but I am operating on people’s thoughts and feelings…and if something goes wrong I can destroy that person’s character….forever.”

Driven by the need to help others where they can, this film is about medicine, surgery and health in general, and about life and hope in particular. I watched the film in between observations at an Emergency Department and both shed much light on each other as well as many of the recent posts in the blogsphere.

Searching sites about collaborative health interactions, I am always taken back by the vast amount of articles about informed patients; educated patients; empowered patients and increased medical information accessible to patients. Clearly, these are great things and for many, a step in the right direction for healthcare reform. But as many patients enter the clinic telling triage nurses and doctors they know their symptoms and they know what they have – why do patients still go and what difference can medical practitioners make when for many, things are always-already decided?

Patients entering the clinic in Ukraine have very different motivations for going. It is less about reassurance and more about information. Patients form a line and determine, together, who is in need of care the most. And at this particular clinic, patients rely heavily on words - as our clinics do - but words across the pond are used for enduring purposes. Words become the way hope, despair, medicine, cure and care are created. Words like “there is nothing we can do for you;” “you must stay awake doing surgery while we remove your brain tumor because we don’t have the medicine;” “your daughter is blind and we can’t change it” or “you have 5 years to live and your vision will worsen because of your tumor and will eventually go before those 5 years.” These words carry weight and these words certainly challenge our taken for granted assumptions and expectations of medicine and care. We as a society are very good at trying to identify problems and endlessly generate solutions like universal healthcare; comparative effectiveness research; electronic medical records and empowered patients. But what exactly is the issue we are trying to address or “solve?”

The Emergency Department I have observed dances intricately with questions about illness and health and to a lesser extent life and death. Furthermore, societal demands of “save” and “fix” as well as time demands help construct what it means to be a patient and a provider. Clinic observations and conversations taken together with this incredible film has left me feeling hopeful because of their (in both cases) ongoing willingness to try and help others where they can. But at the same time, both have left me feeling frustrated as many articles written are stripped of the complexity of clinical and surgical life. I encourage you to see the film, reflect on a few questions and keep the conversation going…!

Why do you go see your doctor?

What does it mean to give people hope?

What does it mean to survive?

As always, we look forward to your thoughts…

With thanks to SantiMB and Daniel Y. Go for their photos.

Carey Candrian

Tags: brain surgeon, brian surgeons, collaborative health interactions, comparative effectiveness research, department of emergency, doctor-patient relationship, Dr. Henry Marsh, electronic health records, electronic medical records, emergency department, empowered patients, emr, humanity, medical hope, surgery, surgical powers, the english surgeon, triage nurse, triage nurses, universal healthcare

This entry was posted on Tuesday, March 10th, 2009 at 7:23 am and is filed under Blog.