I recently finished a two-week inpatient rotation at the Veterans Affairs hospital. At the end of the rotation, the third-year medical student who was working on my team, and whom I bonded with, handed me a letter. I waited until my shift was over before slipping the paper from its envelope. The previous weekend was my day off and she was working, taking care of our mutual patients with the rest of the team in my absence. Her letter began:
“I’ve learned a lot in my almost 8 weeks on medicine, and almost 1 year of clerkships, but there are a lot things I’m still learning about patient care.”
She was a particularly strong student, very confident in her answers but also respectful and helpful; always looking for ways to make her patients smile or lighten an intern’s load. As an intern, you need to be task oriented and often times can get caught up in your daily grind without realizing that you too, can also be a teacher.
The letter continued:
“Today started off depressing; I felt like a robot doing things just because they needed to get done…I felt like there wasn’t enough time to really sit down and talk to him [our mutual patient]…”
It was surprising to read those words. This student always seemed very positive and upbeat, never would I think of her having a depressing experience in the hospital. It made me sad because, at such an early stage in her medical career, she was showing signs of struggling with the system as I do. The medical system puts up barriers to the very reason we go into it in the first place. All too often we are not afforded the proper amount of time to treat patients as people. It is not that doctors mistreat patients, quite the opposite, most doctors care deeply for their patients and take excellent care of them. It is a systemic problem with healthcare where an immense amount of administrative pressures are thrust upon physicians to see higher volumes of patients, document charts, fill out EMR paperwork, and a million other tasks that place us in front of computer screens instead of by the bedside. Connecting with my patients is some of the few moments in my day that remind me why I became a doctor and gets me up in the morning. In a way, it was reassuring that my student was also feeling these pangs of humanism because it reaffirmed that the right kind of people are going into medicine.
“…Even though it was so rushed, after each patient that we talked to, I went up to them, held their hand, and told them we were going to take care of them, and mentally tried to transmit all my care and concern from them in this one gesture…it’s something that I picked up from you.”
I think as an intern, we forget that how we conduct ourselves in the hospital, in even the subtlest of ways, may have an impact on others. It’s very easy to see myself as still a student, after all , am only a few months removed from school, I have not yet mastered most of medicine (or any?), and despite the length of white coat, I still have a sense of seeking the approval of your superiors. I often feel that my medical students know more textbook medicine than I do. Never would I have thought that my holding a patient’s hand, or a brief interaction that I may have with someone in pain, could ripple and affect a colleague.
There is the explicit medical knowledge we all crammed into our hippocampi. Then there are the more implicit ‘soft skills’ I do not think can be taught but rather emulated. Just as I have been emulating attendings and residents whom I have learned from, it humbles me to see these sentiments being passed on. The farther I have come along in my medical training journey, the more test scores become irrelevant compared to what patients get from a genuine act of kindness and care. Facts can be looked up. Compassion cannot.
And sometimes, you can learn from your students. Thank you for this letter. Thank you for showing me that humanism is still very much alive in medicine.