Medical Student Reflection V

by Academy of Clinical Excellence on August 27, 2013

Perhaps I learned just as much from providers as from their patients, for the artwork of clinical excellence is displayed through the medium of patients' stories. In fact, I felt that patients of these physicians differed from others I have seen; they differed in the fact of wanting to open up and share the good and bad, willingly wanting to reflect on their experiences. Maybe this is a result of the culture the physician helps create: one of openness, healing, and participation rather than one that is closed, directive, or hierarchical.

I saw examples of meeting a patient in his own construct/worldview/ paradigm of understanding (whether 'immature' or 'correct') instead of attacking issues from one's own view of 'what you think is going on.' In this way, the provider became an assistant to the patient, helping him progress in his own life story. And sometimes, as seen in addiction counseling, the role of the physician advocate becomes a very dramatic role in this story: helping him realize he wants to be the 'protagonist' and author of his own life story instead of playing merely a minor character and observer of all these things that are controlling and directing him. But on the other extreme, the physician guarded herself from becoming the omnipotent director of the story, for this creates a dependence that again removes the patient from autonomy of his own life. A great example of keeping this in check was the acknowledgment of having a limited expertise, of letting the patient know when the answer is not clear or known by you. And even once in referral, still walking alongside the patient and keeping his best interest at heart by referring with a specific question to be answered and by following-up with these points upon seeing him again.

At the end of this rotation, I have begun to realize how the art of a clinician shines in display on the canvas of the patient. And so what is the role of the 'problem patient', the difficult and non-compliant? Maybe in this more intricate interaction - this testing by fire - can only true compassion and excellence be demonstrated. So I ask myself and all providers this question often: do you practice medicine for the patient who is grateful or for the one who pushes you away? From where do you get your satisfaction and reward?

Phillip Mote
M.D. Class of 2015
Johns Hopkins School of Medicine

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