Forecast (Ep 12): The Physician's Role is to Care

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Anaesthetist and intensive care doctor Matt Jackson shares insights from his medical work and his Christian faith. Whereas he once thought a doctor's role was to heal people, his experience and reflections have taught him that instead, his role is to care for people in difficult situations. He describes moments of fulfilment supporting his patients and their families in COVID-19 times. Host: Josh Seligman

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Below are excerpts from today's Forecast. This transcript has been lightly edited for clarity and concision. 

Perspective
As with becoming a doctor and as with my conversion, I suppose there's no real Damascus moment of 'I had a patient die, and then suddenly I had this big revelation', but the suffering that I see at work can sometimes be a real stark reminder of how blessed I am in my own life. Sometimes seeing the struggles and difficult situations people come from can be a real reminder of [how] my own life's really good and really blessed. I know it's quite a trite point, but I certainly get to the point where I sweat the small stuff, and I'll be irritated or thinking or frustrated about a particular thing and then suddenly realise, that's not important, that's just the small stuff. Seeing so many people's lives, particularly at the point where it's hitting crisis, as in my own job, is a good mirror to understand some of the things that are important in life and some of the things that are just sweating the small stuff.

Not just solving problems
I'm a work in progress. Sometimes I look at myself and know that I'm not the most caring of people.

I think the job that I do requires me quite often to look at difficult situations that people are in and come up with solutions. One of the mentally protected ways about coming up with those solutions is kind of to dehumanise a problem or just to see it as a problem that needs solving.

It's useful to have regular reminders. When you sit down with a family who are upset, that is a regular reminder that actually, what I'm doing in my job isn't just solving problems, isn't just applying academic knowledge. It's dealing with fellow human beings. It's dealing with other people who are children of God, and I guess in that sense, I'm very much a work in progress. Those points where I am reminded are humbling and are important, really.

The role of the physician is not to heal, but to care
Ten [to] fifteen years ago, I was having this slight dilemma: 'What is it that I do as a doctor? What's the point of it? I kind of know what society expects of me. I know what my contract expects of me. But on a more philosophical level, what is it that I'm supposed to be doing?'

There's very few diseases that I see where I can heal someone. Quite often, the treatments that I have will prolong life. They can improve the quality of life. There's always the risk of side-effects, but there's very few treatments that we have available that are actually ever going to fully reverse and get rid of a problem.

I guess naively, I'd always thought that if I'm going to be doctor, then a doctor is a healer, but actually, that's really not the case...I'd always wanted to help people and make people better. And as I progressed through my career, [I had] just the recognition that none of the treatments we have available actually make people truly better. They don't bring about complete transformation of the disease process such that it's gone. We can prolong life, we can improve life, we can improve the quality of life, but we can never completely click our fingers and completely evaporate a problem away.

As I was growing up and developing and maturing, it was part of the maturing process just to understand that actually, this concept of medicine being healing or completely making people better isn't quite true.

Then the question is, well, what is it that I actually do? What is it that I'm actually able to do?

Ultimately, it falls down to, yes, there are lots of technical things that I've done, that I can do. I've spent a lot of time being trained to do these things. But ultimately, if you peel it back and back, Stanley Hauerwas has written about this really well: ultimately, what I'm doing is, I'm caring for people in difficult situations.

And I suppose another way of looking at it is, if as a doctor my job is to make people better, when my patients die, am I a failure? Is that a failing?...If you've got this paradigm that doctors make people better, doctors heal, then ultimately yes, you are failure. But some of the most rewarding experiences I actually have professionally are when patients do die and to have been able to provide a comfortable death, enable people they love to be around them, to have enabled them to have that time to acknowledge that death's coming and be able to have those conversations that they want with their loved ones at the end of life. To be part of the team that's facilitating that, that feels good. That feels the right thing to do.

This suggestion that the role of the doctor -- it's not really doctor, it's any healthcare worker, and perhaps you might extend it to 'Everyone's job is to care' -- but particularly thinking about the healthcare realm: actually, our job is to care for people in these difficult situations.

Glimpses
Particularly with COVID-19 around, in a lot of our hospitals, visiting is very difficult and really minimis[ed]. Facilitating visits to patients and seeing the benefit that that has, having loved ones around, is particularly resonant at the moment with me.

Because certainly where I work, visiting is really limited to just people who are coming to the end of their life. And yet just enabling FaceTime, the WhatsApp video calls with patients -- someone who's been in hospital for a while, their mind's in a position where they've started to question whether they're ever going to get better, fully get out of hospital -- and then just to see the spark that suddenly that call, seeing their family's face on a tablet or a phone brings to them, just to be part of that, that's really rewarding.

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Matt Jackson is an anaesthetist and intensive care doctor based just south of Manchester, England.

Josh Seligman is the founding editor of Foreshadow and a co-host of For​ecast.