The Good Doctor – JAMA

Shekinah Elmore, medical student and rhabdosarcoma survivor, has a fantastic piece in JAMA about humanism in medicine. How can we educate medical students to preserve the caring instinct?

From the first day of orientation, we’re taught that medicine is holistic and humanistic and should always be infused with genuine care for patients in addition to routine patient care. Perhaps predictably, this emphasis degrades. And, not slowly, as I expected, but rapidly, declining with a speed inversely proportional to the rise of basic and clinical sciences. In anatomy lab, in the name of efficiency, we move feverishly around and through the bodies of our donors, focusing on nerve, muscle, bone, attachment. Eulogizing takes words, and words take time. We are given only two hours a day over the course of six weeks to learn what we can of the whole human composition. “Flexor carpi ulnaris” is all that’s uttered when lifting the hand. A hand. Her hand. Nerve, muscle, bone, detachment.

Medical students and physicians are all touched by illness. During hundreds of lectures  on pathology and disease, there’s surely someone in the audience whose  brother has Down Syndrome or who personally struggles with an autoimmune disorder. It’s these experiences that ground us, helping us to remember the value of patients’ personal journeys (and insight) while we care for them.

A more informal curriculum, then, will inevitably be responsible for preserving the empathy of physicians in training. What will this “curriculum” entail, and can those of us who have experienced illness, directly or indirectly, participate in it? This writing is an attempt, but there are many unspoken barriers. Medical students, like physicians, are imagined to be among the well. We are not supposed to carry that dual passport from the land of the ill. Our professors reinforce this, calling us young, healthy, and “without clinical findings.” Relatively speaking, I am all of these things. I am ambulatory. I keep up well with my classmates. But when a friend turns to me in tutorial as we are discussing pulmonary physiology, saying in all seriousness, “You know, you can live with one lung,” I am only able to pause and respond, “Yes. Yes, I know.” She looks at me, quizzically. I have lived more than a year with just more than one, just less than two. She is not in a position to know this because I am not in a position to tell her. In our training thus far, being a patient seems more a liability than an asset. We need to be taught explicitly to trust patients, taught that they’re as valuable as physicians in our education, because although they have not seen 100 VATS lobectomies, they have experienced one. And, from my own experience, one is quite enough to offer some real insight.

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Filed under Cancer, Education, Hidden curriculum, Humanism

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