The right to cynicism?

My very first patient in medical school, which I encountered while shadowing a 3rd year student for a day during orientation, was a man at Cooper Green with rectal bleeding.  What better way to welcome a student to medical school than allowing her to do a rectal exam on her very first patient... so naturally, that's what I did.  He had the worst case of anogenital warts I will likely ever see--how he managed to defecate at all was beyond me.  I felt bad for what he was going through but, like most medical professionals, treated the situation with a good bit of cynicism.  If it had been me, I would have never let a medical problem go that long without seeking help.  These poor people, I thought, they're so uninformed about medicine that they have to be really sick before they realize something isn't normal.  

I now imagine that this man was more than informed about his condition.  He realized what it meant to have anal cancer more than I ever will.  He likely knows a few people who went to the doctor when they thought they had a minor problem, and likely all of those people came home to their family and friends with a "death sentence"--cancer, kidney disease, lung disease, heart disease, etc.  How many family members, classmates, close friends, even friends of friends, do I know who are living with a death sentence? None. Maybe one or two, out of thousands of people. Based on personal experience, my likelihood of having cervical cancer at my next gynecology appointment is slim to none.  But this man? He knew what was coming, and we are kidding ourselves if we think blissful ignorance is any part of his life.

Until this semester, I thought that what health care needed was more free screening, more free services, more education.  I had the right idea--that health care in the United States is totally built the wrong way, with little to no emphasis on primary care services and primary prevention efforts.  Access to care is still a huge problem--you can walk into any emergency room and see that--and I still have a heart for the issue.  But, actually, we haven't done too poorly at making programs available to those who can't afford it.  This has been trending up since the '60s, so we have the hippies of our parents' generation to thank for that.  What we need now is people. Health care workers who aren't cynical.  People who refuse the idea of stigma.  People who aren't too haughty, or scared, or comfortable to share life with rougher communities.  We need to increase the proportion of healthy people in the networks of those communities, so that they have success stories to base their life on instead of a bunch of failures and death sentences.  

Even the most well-meaning people--mentors of mine in my road to health care for the homeless, have told me, You're gonna have to develop a healthy cynicism for this calling to avoid being burned out.  These people just aren't going to do what you tell them to do, and it's exhausting without a putting a certain amount of guard up.  Here's what I have to say: what the crap is healthy cynicism, and why should I feel like I have a right to it?  The point that I feel like I need to be cynical to get through the day is the point that I have stopped relying on God to get me through the day, and the point at which I cease to be a truly healthy influence in the lives of my patients.  What I want to do is not a job to me.  It's not something I want to get through from 9 to 5 so I can leave work at the door and sleep at night.  If that's what medicine (or whatever your job) is for you, then I would say you have some soul searching to do. For me, it's a calling toward a lifestyle, and cynicism has no place in it.

The article that inspired this post:

von Wagner, C., Good, A., Whitaker, K., Wardle, J. (2011). Psychosocial Determinants of Socioeconomic Inequalities in Cancer Screening Participation: A Conceptual Framework.  Epidemiologic Reviews, 1-13. DOI: 10.1093/epirev/mxq018