The Path Toward Clinical Excellence

by Academy of Clinical Excellence on June 9, 2010


As a physician in a teaching hospital, I have the privilege not just of caring for patients, but helping young doctors learn how to best care for patients. We work as a team, but the intern – or first year physician – is the patient’s primary physician in the hospital. Much of my job is to listen, observe, and help guide the intern into doing an even better job than they are already doing. Sometimes we focus on how to treat a particular disease, or what test is best to order to diagnose a condition. Other times the learning happens around communication and counseling skills. Sometimes I get really lucky, and get to observe the unique and important relationship that develops between a seriously ill person and his physician.

The gentleman had been fighting cancer for several years, and had reached the point where treatment was ineffective. His oncologist was beginning to discuss halting treatment and opting for hospice care. He was admitted to the hospital with fatigue and a possible pneumonia, but he was most interested in being able to ski again. He was very weak, but felt that he would improve and be able to get back to what he loved.

I sat and watched as the intern on my team sat down by him on the bed, and talked with him about skiing. How much he loved it, where he liked to go, and how they shared a love of the sport. They talked about his goals, and what he was most worried about. We learned how hard it has been from him to live with cancer, and how his fatigue has made it difficult for him to do everyday things like taking a shower.

The physician-in-training did a superb job understanding our patient’s priorities and what was important to him. They connected on a personal level which, for a moment, allowed the gentleman to escape from the hospital and imagine himself on the ski slopes. As a clinical teacher, I was convinced at that moment that this young doctor was moving down the path towards clinical excellence.

Laura Hanyok, M.D.
General Internal Medicine
Johns Hopkins University School of Medicine

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