I’ve always felt strongly that it’s not really fair that we ask clinicians to be experts in patients when there is so little access to us, so when I started this blog, I looked for way to reach schools beyond Georgetown Medical School, where I give an annual talk driven by about 400 medical students. They ask, I answer.
The advice I got most often was to get involved in Grand Rounds.
For those of you unfamiliar with Grand Rounds, that’s when a doctor goes on rounds at a hospital accompanied by young hopefuls, and they discuss you and your case as if you weren’t there. It is a time-honored tradition of how not to communicate with a patient.
Luckily, it appears that the medical establishment is starting to realize the flaws in Grand Rounds as a teaching tool. NIH wrote an article.
The problem is, there haven’t been a lot of ideas about what should take its place. There is an opportunity here. Medicine is one of the most innovative fields there is. In fact, one of the issues that crops up more and more lately is when medical innovations often outpace policy, laws, and the establishment itself. The gap between when the new innovation becomes available and when regulations take effect can cause hiccups.
Nevertheless, the drive and creativity are there – in drug development, in payment systems, even in how the industry is starting to include patients.
Everywhere except medical education.
Generally speaking, medical education does not mandate, or even offer, communication classes. Patient communication may be woven into other classes – a chapter here, a unit there – but there is no emphasis on collaboration, on reading the room, on adapting to a patient’s needs and meeting them where they are. New students are taught by professors who were immersed in older techniques, who were taught by professors of even older techniques.
Once in a while, I hear about a particularly forward-thinking curriculum, which features one patient on a panel in one class, speaking about their experience with one specific condition. (For the record, the class I speak with is 1-2 hours, just me and my doctor, plus however long it takes after the class to answer all the questions we didn’t get to, and we speak a lot about communications and intersectionality between conditions.)
This is a step forward, but it isn’t nearly big enough.
Ideally, medical students should have access to patients who can answer their questions throughout their educations, maybe even on call. Yes, it’s good to hear about the emotional impact of a condition, and to offer insight into the patient experience from the people who live it, but what about problem-solving? Shared decision-making? Helping patients figure out what is possible, how far they can go even with their conditions, or where their limitations might lie?
How much better would it be if we arranged access to patients early and often? Offer brown bag lunches or single-credit courses? I don’t think medical schools have January terms, and if they did, I’m not sure the students would go for using their break for more work, but they might if it was incentivized properly. One lecture could go a long way.
I think it would really change things – students moving into the workforce would be more open-minded, more prepared to work with patients, and less emotionally burdened right out of the gate (when clinicians work with patients instead of against us, shifting some of the responsibility for treatment to our shoulders, the emotional burden drops).
Sounds good, right?
But there is one elephant-sized obstacle lying across that path. Though most of the people I have spoken with are conceptually enthusiastic, I haven’t yet met anyone willing to discuss concrete possibilities. They don’t follow up, or they can’t envision a professor willing to give an hour to patient insights, or they are looking for someone with a higher profile.
(Of course, it doesn’t have to be me. Any patient willing to share their experience can make an impact.)
And without the schools themselves, it just ain’t gonna happen.