Medical Student Reflection XIII

by Academy of Clinical Excellence on December 11, 2015

Reflection imageDuring my two weeks with clinicians from the Miller-Coulson Academy, I found myself reflecting quite a bit on where I was 10 years ago: living on an 88-foot schooner in the Caribbean Sea during my senior year of college, learning from amazing people from all over the world. How’d I get myself thinking about that? Well, It wasn’t just the cold weather and rain in Baltimore; I started thinking about story telling.

During my time living and teaching on sailboats, I always looked to effective captains who were able to captivate, inspire, and understand their crew. Back then I realized that one key ingredient was being an incredible storyteller because when living full-time on a boat with students and professional staff, it takes grace and incredible communication to run a boat smoothly and safely. With the Miller-Coulson Academy, I realized that the clinicians used many of foundations of good storytelling that I learned many years ago to provide extraordinary care to their patients.

  1. Know the story background before you start
    1. You can’t tell a good story unless you have it laid out in some logical way and without understanding the context. Every physician that I worked with provided an illustrious briefing about EVERY patient before we went into the room (Somehow Dr. Duncan ran his whole 20+ patient list with unique details about each patient). They knew why the patient was coming in and could provide a background that made me feel like I already knew the patient before entering their room. They gave me context and background.
  2. Be present
    1. On a boat, that means eye contact with all the crew and being aware of how they are responding to a story – often this can give insight into interpersonal struggles within the crew. All of the MC physicians walked into a patient room with enthusiasm and awareness, sat down next to their patients in an inpatient room, shook hands or gave hugs, garnished cards, but mostly, they were focused on their patients and the trainees throughout the visit – without wavering when the opportunity presented itself.  Most, in fact, left their cell phones in their office as to not be distracted.
  3. Engage your audience
    1. On boats, this sometimes means, calling out crewmembers by name or having them add tidbits to the story as you go. In the clinical setting, this meant turning the computer screen to review records and type with the patient watching or dictating your whole note with the patient, family, and care team in the room (way to go, Dr. Kraus!).
  4. Remember details
    1. A good story is made through context and details, whether it’s explaining the specific sea conditions or knowing about a patient’s favorite restaurant. Dr. Peairs, Dr. Fingerhood and Dr. Christmas were truly outstanding at this – frequently able to speak endearingly about complicated social issues as well as exciting details of a patient’s life. By focusing on details about a person, these physicians are also able to pick-up on nuanced details about the health of their patients -- such as loss of interest in activities or unsafe relationships. It’s the details that make a story worth listening to and it’s the details that make a patient-physician relationship.
  5. Do not place direct value judgment, but editorialize when necessary
    1. As the captain, it’s important not to ostracize young crew (especially the college age student aboard), but frequently it’s important to speak from experience when highlighting points in stories, particularly when used as anecdotes for teaching. Good physicians do this frequently whether telling patients about prior patient experiences or helping trainees understand processes (as Dr. Greenough did effortlessly with each patient we encountered – from discussing how wounds heal to how patients experience the modern technologies of wound care to how to improve modern technologies based on his years of practical experience).
  6. Know how to sum it up and deliver the punch line
    1. At the end of the day, a great story builds to a crescendo and good storytellers do this masterfully after years of practice. For good clinicians, this comes in the diagnostics and assessment/plan – through years of experience, the mastery and grace of diagnosing and treating an illness to improve the life of the detailed and nuanced patient that you have gotten to know is what makes the Miller-Coulson Academy clinicians truly excellent at care.

Over the last two weeks, it has been a pleasure to reflect on a character-molding experience from a decade ago in my final year of college and to realize that the last two weeks, in my final year of medical school, will likely be something that I reflect on a decade from now as I start to mold my own practice. Here’s what I know so far: It’s hard to tell great stories, especially day after day, but excellent physicians have mastered the tenets of great storytelling in clinical practice, day after day, patient after patient.

Julia Riddle, MS 4

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