“It’s just, like, acting like a human.” A fellow first year medical student eloquently summarized our Principles of Clinical Medicine class. The “techniques” we practice seem basic on first glance: Express the patient’s Chief Complaint in their own words. Ask the patient to describe the Onset of his or her symptom, what Provokes or Palliates it, it’s Quality, and so on and so forth to the tune of a convenient acronym. Explore socioeconomic or psychological drivers of a patient’s ailments by asking how her life is going, what affects her the most, and how she is coping. Always, always, even when the acronym does not explicitly ask, show Empathy. Also, wash your hands and clean your stethoscope between patients.
As an altruistic human being who has chosen the Noble Path of medicine, practicing these “common sense” communication skills should be easy for me. It’s just, like, acting like a human.
Two days before our first GIE exam, tensions were notably high. I found myself snapping at a lab partner, interrupting her question to ensure that we finished our dissection. I was terse with my boyfriend: when he expressed a long-standing and perfectly valid concern about our relationship, I burst into tears and sidetracked the conversation with my own issues. Strangely, the “basic human skills” taught in PCM slipped to the wayside when “medical school emotions” turned on high. I did not ask my partner when the Onset of his frustration was, or how I could Palliate it. When a student asked one too many questions during a review, I did not reflect on her psychological state. I did not repeat my lab partner’s Chief Complaint (or question) back to her in her own words, ensuring that it was answered comprehensively. I showed a marked lack of Empathy for fellow drivers on 26W.
Many aspects of medical school training bring out our humanity. Before mastering the brachial plexus, we become guardians of patients’ secrets, fears, and confessions. We spend hours examining our donor bodies, inevitably pausing and wondering about their lives and their deaths. We share our often deeply personal motivations for choosing this path over a hurried coffee or a more relaxed beer. However, medical school can be deeply dehumanizing. Though we maintain a patient focus in our clinical encounters, for many of us, our personal lives become more self-centered. We spend more time studying, paying attention to our own habits, memory, and sleep cycle, perhaps less time actively listening to our friends and colleagues and, perhaps, even less time demonstrating Empathy to the classmates, professors, and loved ones supporting us through this journey. Some of us neglect long standing rituals, from a daily run to hours of television on Saturday morning, to achieve our academic goals. So though it’s impossibly cheesy, I purport that maybe the practice of being human, like memorizing abdominal innervations, takes practice. I purport that we need to pause to ask ourselves how we are coping, which challenges affect us the most, and how we are handling medical school, with its unprecedented demands on our hearts and minds. Even if we didn’t need to before, we now need to practice seeing the world from other perspectives, whether or not we’re wearing our white coats. Maybe demonstrating Empathy, like understanding the autonomic nervous system, is a more daunting task than one would expect. For the sake of our patients, families, colleagues, and future selves, I hope we are all up to the challenge.