Medical Student Reflection IV

by Academy of Clinical Excellence on January 25, 2013

A number of times during medical school, I’ve been told that as time passes, it becomes easier and easier to see patients as cases instead of as people.  After starting life on the wards, I realized how quickly this mentality begins.  In just a few weeks, my fellow medical students and I started discussing patients before rounds in terms of their diseases instead of their names.  We even started using impersonal language when talking about our patient load.  “What do you have?”  “I’ve got the purpuric rash, the FUO, and the UTI.”  Thinking about that now, the conversation just sounds wrong somehow.  Patients aren’t “whats,” they’re “whos.”  Why is it that it’s so natural to depersonalize them?  Is it just a habit we’ve continued to pick up from our superiors? Is it because diseases are easier for us to remember than names? Or because we take more interest in the illnesses than the people? Whatever the reason, I think there’s a consensus that it’s generally best to try to resist this habit. 

During my time on the elective in Clinical Excellence with the Miller-Coulson Academy, I shadowed two physicians, in particular, who made an effort break away from this trend.  One doctor asked one of his patients, a man with a rare demyelinating disease, to share his story with me.  The man had been through a terrifying experience – having his body shut down while his mind was completely aware of what was happening.  At the peak of his disease, he required ventilator support just to stay alive, and he was able to tell me in detail how scary that was.  After he had recovered enough to no longer need life support, he began several months of grueling physical therapy to regain as much motor function as possible.  When I met with him, he was sitting up eating lunch – unassisted – and was able to tell me the entire story himself, albeit with a little difficulty.  I was amazed to find no evidence of frustration or self-pity as he told his tale.  There was no part of him that wanted to give up or to ask “why me?”  All he had was appreciation for being alive and determination to get back to his normal life.  When I thought back about the experience later that evening, I didn’t think of “the demyelinating polyneuropathy.”  I thought of Mr. S, a man with an incredible story and an even more incredible sense of determination.

A second physician, who taught me to look beyond the condition and really see the patient, introduced me to a woman with chronic pain from sickle cell disease and invited her to tell me about her experience.  A few minutes into her story, she began to weep.  This woman, who had a successful work life and a family that loved her, said there were times when she had felt like “throwing in the towel” because the never-ending pain was too much to bear.  Even though she otherwise had a great life, the lifelong struggle with pain was enough to take the enjoyment out of it.  While she was in the hospital for a sickle cell crisis, her team was working to develop an effective pain regimen for her.  She was tired and felt beaten-down from the flare in her disease, but she had hope that things would get better.  As the attending physician and I were walking away from the patient’s room, she turned to me and said: “When you’re on your medicine rotation and your team admits a patient with chronic pain, don’t just think ‘oh another patient with chronic pain.’  Think of her and her story.”

- Rachel Meserole, MS III

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