November 1, 2017 by
On Tuesday, October 24 at 4:00 pm, a group of seven first-year UVM medical students donned their white coats for the first time professionally and followed their Professionalism, Communication and Reflection (PCR) course preceptor, Shaden Eldakar-Hein, M.D., through the halls of the UVM Medical Center (UVMMC) and up the stairs to Baird 4.
To the untrained eye, the students looked every bit like doctors rather than doctors-in-training. Yet, taking in the length of their white coats, their "medical student" attachment hanging under their ID badges, lack of stethoscope and other basic "tools of the trade" hanging around their necks and shoved into their pockets, and their somewhat uncertain but determined expressions, it became clear they were just beginning their journey on the road to becoming physicians. Today, they would reach another important mile-marker on that journey - an in-person interview with an admitted patient.
The purpose of the assignment?
"In response to repeatedly stressful and sometimes traumatic interactions with patients, doctors sometimes start to partition off their emotional response to their work. A parallel partitioning strategy involves detaching patients' lives from their illnesses and relating to them as if they are sets of symptoms and test results," Lee Rosen, PhD, the course director for PCR and UVM lecturer in the Psychiatry Department, reminded the students the day before their patient visits. "We're hoping that you will, early on in your training, cultivate ways of being fully present with yourself and your patients, and that you will be inclined to share your experiences with colleagues and other professional on a regular basis in order to get support and feedback. This session is an opportunity to consider this process and start practicing."
Prior to their foray into Baird 4, the students completed several readings on the field of narrative medicine including one by Rita Charon, M.D., Ph.D, a professor of medicine at Columbia University and the originator of narrative medicine.
Then, armed with the words and knowledge of Dr. Charon and their preceptor, Dr. Eldakar-Hein, the students were led, one-by-one, into the rooms of patients on Baird 4.
For some, the experience was one they've had previously, albeit in a different role. First-year student Jack Dubuque was a nurse at UVMMC for 5 years and worked with patients both in Cardiothoracic and Vascular Surgery and the Emergency Department. For Dubuque, the assignment was another opportunity to hone skills he developed over previous years in medicine. "Speaking to patients, I've learned that each patient has a unique story about how they found themselves in our care in the hospital," he said. "I've found honesty to be the best policy and to treat each patient as if the day I am seeing them is the worst day of their life."
For Annabelle Davey, the assignment initially proved to be more stressful. Before the visit, Davey, noted that she was worried about not having enough to talk about with the patient. However, Davey's anxiety quickly diminished as her conversation with the patient, a retired nurse of 30+ years began. "I had several questions prepared before I went in the room," Davey said, "but I didn't up getting to them because we were having a nice conversation and I didn't need the prepared questions to move it along."
Menna Awadalla fell somewhere in between Davey and Dubuque in terms of her experience. Awadalla has worked with patients before like Dubuque but found that she was still nervous like Davey on the day of the patient interview. "In this case I wasn't directly offering them my service, rather, I was taking something from them," she said. "Here was this person, possibly in pain, and probably not in the mood to chat with a random stranger. I really didn't want to inconvenience them."
However, like Davey, once she started speaking with her patient, her perspective changed. "I felt like I was chatting with colleagues," Awadalla said. "They included me in their care and opened up to me with full disclosure." In addition to the patient's willingness to speak with Awadalla, she found that their family members also offered her invaluable insights. "I got so many different patient perspectives," Awadalla recalled. "[Not only] the family's perception of their family member's care at the present time, [but also] each family member's own experience being a patient at [another] point in time."
Both Awadalla and Davey found the task a welcome supplement to the PCR course. For Davey, it was a chance for her to speak with an actual patient, something she hadn't been able to do before. For Awadalla, the experience helped her reflect on previous experiences she's had and reminded her to "take a step back and actually ask about the patient from a social standpoint." She noted that the lesson highlighted how important a patient's narrative is in treating them. "Patients are more than signs and symptoms, they're people," said Awadalla. "I think sometimes it's easy to get lost in that when we feel stressed with a workload."
Although for some students, this wasn't their true first interaction with a patient, at the end of the day, most still felt the activity taught or reminded them of important skills it takes to be an physician - empathy and compassion - skills learned best outside of the classroom.