MS Reflection VIII: “A Dying Breed” or Maybe Not

by Academy of Clinical Excellence on April 20, 2015

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One of the focal events of my Miller Coulson Academy elective happened early on in the course of my two weeks, when I was scheduled to attend the clinic of transplant nephrologist, Dr. K. Unlike many of the other clinics I have attended throughout medical school--where patients are squeezed into fifteen minute time slots--Dr. K had the 'luxury' of hour-long visits with his patients. Naturally, looking at the schedule the night before, I went to clinic expecting a much more relaxed, and less hectic clinic than those I had previously observed.

What I hadn't been counting on, however, was the fact that as a transplant nephrologist at Johns Hopkins, Dr. K's patient panel included some of the most complicated post-kidney transplant patients in the country--some who had even flown hours just to make their appointment. Every minute allotted to each visit, and very often a few more, was spent addressing a wide variety of patient concerns ranging from immunosuppression to mental health concerns to fears of eventual transplant rejection. I was blown away by how focused Dr. K was on his patients, and how much trust they placed in him to manage often very complicated clinical situations.

In one of the rare moments between patients, Dr. K introduced me to one of his colleagues, who was working in an adjacent exam room. After understanding that I was a medical student observing clinical excellence through working with Miller Coulson Academy members, the doctor suggested that Dr. K was a "dying breed" and that his type of patient centered care was "not sustainable in modern medicine." While I understood the validity and motivations behind this comment, I became concerned that the focused, patient-centered care that I had so appreciated in Dr. K's approach was something that may be unattainable in my future career. Surely, I would not have so much time to spend with each patient, so how could I apply what I was learning to my future life?

Happily, my experience with Dr. K did not exist solely in isolation, and instead for the next week and a half, I had the opportunity to work with many other members of the Miller Coulson Academy. Although these physicians had more traditional time constraints, they somehow managed to distill the same focus and dedication to their patients as Dr. K. I realized that patient-centered care can happen in many ways, and with a variety of styles, and can exist even in the changing landscape of medicine. While it may not always be practical to take an hour or more for each patient seen, it is still possible to focus on the patient experience even in a fifteen minute visit. Furthermore, I was gratified to be able to observe patient-centered skills in a wide range of clinicians, from surgeons to primary care physicians to those practicing end of life care.

So in a way, instead of a "dying breed" those who practice patient centered care are an "evolving breed". There are so many ways to be present with patients, and I was able to observe this over the last two weeks. I hope to be able to take the pearls of wisdom that I observed through this elective to continue that tradition of clinical excellence in my career.

Heather Walls, MSIV

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