In the last several weeks I feel like I've jumped down the rabbit hole of medical education theory and research and it's been an incredible learning experience. So much of what I have been focusing on however, is the teaching of medical knowledge, assessment of clinical performance, and diagnostic reasoning. While important, and certainly a necessary component of learning during medical school, as we all know, a good doctor should have many skills beyond an extensive medical knowledge.
A huge shift has occurred in the last few decades in terms of what should be the expected competencies of graduating physicians. I remember having the CanMEDS roles drilled into my head in first year of med school (I even came up with an acronym for them to not forget: CAMSPEC). I remember feeling and thinking that many of these qualities were self-evident; why do they need to be emphasized so strongly when there is so much more to learn in medical school? As I've progressed through medical school however, I've been reminded time and time and time again how my patients remember me as a good doctor, not because I make the perfect diagnosis, right away, all of the time, but because I care for them, I advocate on their behalf, and I take the time to speak with them and explain what's going on.
On my CaRMS interview tour I was asked about my most impactful experience during clerkship. I told the story of a young teenage patient I took care of for several weeks with an eating disorder. I remember feeling pretty helpless in terms of medical management those weeks; after all, my patient was simply in hospital to eat and gain weight, but I still felt like I wanted to be 'doing something' as their doctor. So, I made a point of going to have a conversation every day, speaking not just about symptoms but about painting, novels, their dog, what was going on with school, and even the weather. Gradually they opened up and told me things they were struggling with and I was able to advocate for more time spent outside in the sunshine - a small thing, but something that would really help. I didn't feel like I was doing much, but I was given a letter at the end of our time together, thanking me for my kindness and saying that I had been the only person they felt comfortable talking to in hospital and that I had made a huge difference.
I was floored.
To think that simple kindness of having a conversation, listening, and being present could make such a huge difference to a patient was not something I had expected.
Where did that ability come from though? Have I always been that kind of a person? One who knows when to listen and to be kind? Maybe, but I do think that I've become much better at it over the course of medical school. Perhaps it's just that now that I've had these experiences, I'm much more aware of the influence individuals can have on each other, especially those in a position of power or privilege such as we have in medicine and I exert my abilities in a more mindful manner.
On the other hand, I think medical education has evolved to include the teaching or at least the cultivation of competencies beyond medical knowledge. Beyond being Medical Experts, we are trained as Collaborators, Advocates, Managers, Scholars, Professionals, and Communicators; four years later, I can truly believe that my skill in these domains has evolved but I can't figure out how. Was it explicitly taught? Or did I absorb it from observing other physicians and their interactions with patients? I certainly can remember many instances of being impressed by the kindness and patience that I have seen numerous doctors demonstrate with their patients; equally, I can remember poor examples which I've wished to avoid.
Beyond kindness, some of the physicians I've met, like Dr. HPK, truly connect with their patients. He takes the time to ask questions about their life stories, their histories, their family, and through it all links it to his own experiences (which are extensive) so that he can hold a conversation in an area of interest to the patient. Many times I noticed him asking questions about myself as well. At first I attributed this to him trying to get to know me out of curiosity, but over time it's become too much of a pattern to be as simple as that. He brings these personal anecdotes up with patients too, thereby connecting not only himself to the patient, but his learners as well. And that connection, demonstrated daily by how much his patients show their appreciation, is what makes Dr HPK a genius at not just the science, but the art of medicine.
I'd like to think that my attempts at connecting with my eating disorder patient was a rudimentary version of Dr HPK's style (of my own devising). Now that I've spent several weeks in his clinic, I think I've learned even more how the 'grey areas of medicine' can be served by compassion, attention, and connection. There may not always be a cure, but as I've learned, cultivating these abilities can still make all the difference in the world.
~LG
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