Kiran Gupta writes about her experiences as a resident in the Department of Medicine at Brigham and Women's Hospital. She has done research on domestic health policy issues, including health care costs, medical errors, and end-of-life care, and is a former columnist for the Financial Times Weekend Magazine. Kiran received her A.B. in Government with a certificate in Health Policy from Harvard College and earned her M.D. from Harvard Medical School.
Mr. S lay patiently in his hospital bed while several medical students took turns pressing their stethoscopes to his chest, hoping to hear his sometimes elusive heart murmur. The elderly gentleman had a long cardiac history; he had been admitted to the hospital with worsening shortness of breath several days earlier. His hospital stay had been complicated and he was quite sick.
However, when I gently approached him about participating in a teaching exercise designed to help medical students improve their physical exam skills, he responded with a smile, “Anything to help the next generation.’’
Thanks to his generosity, my team of medical students spent an hour at his bedside discussing the various ways to listen to his heart murmur, thinking about his various heart sounds, and practicing physical exam maneuvers to better understand his heart condition.
Although patients come to our hospital seeking medical care and treatment, whether they realize it or not, they also serve an invaluable role — as our greatest teachers. In the first few years of medical school, we learn about diseases, physical exams, and taking patient histories through lectures and textbooks. But, the opportunity to observe the clinical manifestations of illness at our patients’ bedside is what provides those “ah-ha’’ moments in which the history, lab tests, imaging studies, and our clinical knowledge come together, allowing us to make a diagnosis and offer treatment. As the medical students listened to Mr. S’s chest, I could see their faces light up when they heard his heart. The shortness of breath, increased leg swelling, and crackles in his lungs — it all began to make sense.
As medical training progresses, we tend to spend less time learning at the bedside. In residency, we seem to always rush through rounds so that we can order tests, finish notes, make appointments, fill out discharge summaries, and admit the next patient. While we develop valuable skills and knowledge by doing these tasks, we sometimes lose sight of the person that is our patient. He or she sometimes becomes defined by a condition — even being referred to as the “COPD-er’’ (lung disease), “CHF-er’’ (heart failure), or “cirrhotic’’ (liver disease). We begin to remember patients’ lab values and imaging results, instead of their names and faces. This dehumanization of the patient may be subtle and unintentional, but it is real.
At the end of our time with Mr. S, one medical student quietly spoke up: “What has this been like for you?’’ The kindly gentleman recounted how challenging the last few months in and out of the hospital had been. He described the impact of his illness on his work, his family, and his mental state. Without our acknowledgment and understanding of the role the disease was playing in his life, how it was affecting him, Mr. S would have merely been a “CHF-er’’ with a heart valve problem. The few minutes he took to relate these details to us were perhaps the most educational of all.
A few weeks ago, I was admitting a patient to the intensive care unit. I began looking over her laboratory results and imaging studies, hoping to determine what was going on. Almost every lab value was abnormal. This young woman appeared on the verge of death, but the diagnosis wasn’t obvious. As I worked to piece things together, waiting for the emergency room to call with its report, I remember thinking to myself, “This patient is an interesting case; I could use this for a teaching conference once we figure it out.’’
Minutes later, the young woman was rolled up on a stretcher. I saw her family. Her husband was crying, their two little daughters by his side. I could see how ill she was, her eyes filled with worry as she strained to see her children near the foot of her bed. Gently, my intern and I examined her. She had spent several weeks in another hospital, but her diagnosis still remained unclear. My clinical interest in her rare illness quickly faded into empathy for her suffering. In that moment, as I stood at her bedside, the uniqueness of this patient’s condition and her “interesting’’ physical exam findings mattered only for the sake of providing her with the best possible care.
Patients play a role as our teachers not just by enabling us to hone our skills as we practice the clinical application of medical knowledge. Equally as important, they remind us that in order to provide appropriate treatment, we must take the time to appreciate how their conditions affect them personally. Without viewing illness in the context of our patients’ lives, we as physicians cannot practice compassionate, effective, patient-centered care. To our patients, it doesn’t matter whether an illness is commonplace or rare.
Understanding the hopes, fears, disappointments, and dreams our patients share with us as we treat them allows us to build genuine, empathic, human relationships, and makes us better doctors in the process.