Gabriella Sehres - Patient-centered Ethics: Pathography

Jul 16, 2022 at 03:32 pm by pj

To become an exemplary physician is to master the ‘art of medicine.’ Far too often, the art of medicine gets lost in translation as once, overly eager medical students quickly transition into all-encompassing roles of residency and beyond. The giddy butterflies that once filled our stomachs slowly fade away as we become taken over by sleep deprivation, inadequate self-care, and missed time with loved ones; thus, the unfortunate and unexpected nuances of medicine continue to further exacerbate the feeling of “burn out.” The medical community is once again at cross-roads as each new class of doctors beg the question – “why does medical training have to be like this?” Often, I find myself at cross-roads as I reflect on my experiences that led me this moment: will I succumb to what feels like the inevitability of practicing jaded medicine, or will I somehow find myself to be one of those sought-after, lucky individuals who stayed true to the ‘art of medicine.’ As a caveat, my time as a third-year medical student was influenced by physicians in either or both categories; however, I appreciated a commonality amongst both groups, which was a deep-seated desire to provide their patients with the best care possible despite the force of external factors. More than ever before, the system continues to overwhelm and overturn physicians. A system too powerful to quarrel forces physicians to play the game or let the game play them – which will we choose? 

Now, it’s not all doom and gloom. I believe there are far more perks of being a 3rd (and I believe 4th - I haven’t made it there yet), year medical student than we recognize in the moment. The most glaringly obvious example that comes to mind is our privilege to be a part of a healthcare team - learning, practicing, and collaborating - without the immediate responsibility that follows receipt of the M.D. degree. Although I cannot speak for everyone, this concept has proven true throughout each of my clinical rotations. There is at least one positive experience extrapolated from each rotation, even if it takes a more in-depth analysis to understand and appreciate the experience. 

On my Internal Medicine rotation, my preceptor would always tell the patient “You are the teacher and Joan will learn from you.” This statement puzzled many patients, which I equated to their lack of understanding that to succeed as a physician, one must master the science and art of medicine. Let’s rewind to the second day during the third week of my general surgery rotation. It was a typical clinic day until I picked up a chart for J.M., a 69-year-old female, status post-op week 1 for colon resection due to diverticulitis. As soon as I recognized the name, I immediately recalled all aspects of her surgery and post-op hospital stay as I assisted on her colon resection and pre-rounded on her every morning throughout her hospital stay. J.M. was very pleasant and I always noticed her face immediately lit up as I entered her room; although she was not overly outgoing or talkative, we shared some laughs and short conversation. Plus, J.M always welcomed my daily list of repetitive questions and thorough physical exams. J.M. had a few minor post-op complications so I was looking forward to hearing how her recovery has been since she was discharged from the hospital. Immediately upon opening the door, I hear a faint voice exclaim “Joan! Is that you?”, before I could even enter the room J.M lets out an audible sigh of relief and says, “I was really hoping to see you today.” Of course, I reciprocated a similar response to J.M. and she began by introducing her daughter, who flew in from Michigan, by explaining, “this is the Joan I was telling you about!” I spent extra time answering any questions J.M.’s daughter had and discussing their concerns prior to reporting my findings to my preceptor. Unfortunately, J.M. was not free of post-op complications yet again as we discovered minor wound dehiscence and purulent drainage leading to oral antibiotics, wound care, and more frequent clinic visits. Over the coming weeks, I had the privilege to get to know J.M. and her daughter better, as I spent countless minutes conversing and laughing with them, comforting them, counseling them, and helping J.M. through her healing journey. On our way out of the room, J.M.’s daughter lightly grabbed my hand and expressed her gratitude for the time and attention I gave her mother when she was alone and upset in the hospital. She said “Joan, thank you for instilling a sense of comfort and peace in my mom that motivated her to get better and get discharged.” Wow – has that been the secret to forming successful physician-patient relationships all along? Instilling a sense of comfort amongst patients? It’s a natural human instinct to seek comfort in any given situation; especially, in unfamiliar scenarios exacerbated by stress and worries associated with the unknown. 

Reflecting on my original thoughts and perceptions of the initial encounter with J.M., I was pleasantly taken aback by her level of excitement and gratitude towards me. During her hospital stay J.M. was soft-spoken and somewhat sad and nervous, however, her demeanor during the post-op visit felt like a whole different J.M. I hadn’t thought much about our interactions during her hospital stay because nothing felt different or unusual; for the most part, I interacted with her just like I did with every other patient. But, to J.M. our interactions provided her with a genuine sense of comfort and motivation throughout her healing and recovery. During each subsequent encounter J.M. would always say “I really like you, Joan.” At first, I felt a twinge of awkwardness as I was unsure how to respond, but I soon realized that was J.M.’s way of expressing her level of comfort with me as part of her healthcare team. On the final day of my rotation, I had the pleasure of seeing J.M. for a final visit. I swung open the door, jumped into the doorway, and threw my hands into the air as J.M. and her daughter shouted “Joan!” That moment felt somewhat surreal as the three of us burst into laughter. At the end of the visit, unbeknownst to her, J.M.’s daughter referenced the ‘art of medicine’ as she pleaded for me to maintain my personable, compassionate personality and prove that surgeons can be nice people. We have formed a genuine, symbiotic patient-student relationship that will forever serve as my gateway into exploration of mastering the ‘art of medicine.’