March 10, 2011
The residents rushed to my bedside in the middle of the night, a young Israeli woman leading the charge and jumping onto my bed to insert a tube through my nose and down my throat. “Wait!” I cried out. “You don’t understand what just happened.” But the young doctors descending on my room could not be stopped. I was vomiting, but not from the aggressive cancer surgery. That had been a week earlier. Rather, I was emptying my insides because of hallucinations from quitting morphine cold turkey. I was perfectly lucid, if only they had stopped to listen to me. I threw the tube against the wall, the new docs out of my room.
“Interns and residents on the floor see their work as a paramilitary operation,” an older attending physician explained the next morning. “You were right, and they just were not listening.”
Teaching new physicians to listen and, more important, to actually hear, is, I believe, missing from medical school training. The traditional medical school formula keeps students in the classroom for the first two years, and then throws them into exhausting 36-hour shifts at teaching hospitals. Making it through the hospital training becomes its own struggle to survive. Too often, patients become cases, not people, a collection of symptoms rather than human beings with real stories and real feelings.
There is a way to inject humanity into the system, but it has to start on Day One, when medical students still remember why they wanted to become doctors in the first place. First-year medical students should meet real patients during their first week at school; some schools require this already, but most do not. They should travel alone or in pairs to people’s homes. That’s where patients feel comfortable, and where they are most likely to speak their truths openly.
Older people will treat these students as physicians and probably be thrilled that the students look them in the eye instead of focusing on their charts. Medical students soon will learn the power of story, that it is not just the clinical information that matters. A vulnerable job situation, a troubled marriage, a kid who smokes marijuana are salient realities that bring something to bear on illness and challenged health.
Doctor-patient relationships need to be nurtured in routine care over time. That process must not wait for a crisis and begin in a hospital. By that time, it’s too late. Patients never get to say what’s really on their minds. And physicians never get to know their patients on all levels.
There’s an empathy gap in medicine today, forged by the limitations of managed care, high-tech medicine and the cacophony of large hospitals. Patient voices have been reduced to a whisper, if they’re heard at all. Medical schools can change that, by protecting young doctors’ capacity to find their empathetic selves. By introducing students to patients early on, medical schools can light a beacon — and hope that it illuminates a path to their best instincts.