How working with addicts taught me the art of bedside manner
My biggest fear when I entered medical school was that I would fail to bring the human element to the practice of medicine. Physicians work with patients from diverse backgrounds, who often struggle with illnesses the physicians have not had themselves. What if I couldn’t truly relate to my patients?
This bedside-manner anxiety reached a fever pitch in August when I was on a flight to California and about to start a week-long internship for medical students at the Betty Ford Center, an addiction treatment facility 120 miles east of Los Angeles. I was thinking about working with individuals grappling with addiction during the coming week, which I had never done before. I wondered how I could help them when I had zero experience with what they were dealing with.
Very quickly, I went from curious medical student to panicky medical student. I’ll be honest: Addiction medicine was not at the top of my list in terms of specialties I considered. But I applied to the Betty Ford summer program in the spirit of seeing what else I could learn.
“As a future osteopathic physician, I want to remember that no matter how many years I spend in a classroom, the patient will always teach me more than I could ever imagine.” Silver
When the week started, I couldn’t have guessed that I would quickly come to admire and look up to so many of the center’s patients. I worked in a men’s inpatient dormitory and soon realized I would miss all of these guys after my internship. The patients I spent time with have been struggling with serious issues, but they are still incredible people. I worked with physicians, entertainers, entrepreneurs, educators and others. They shared a common goal: recovery.
I have never had an issue with addiction in my personal life, but I learned I could relate to the patients because regardless of the problems they faced, the emotions they felt were universal. In treatment sessions, I would remember a moment in my own life when I felt anger, betrayal or euphoria and channel the emotion I felt at that time to better understand the patient’s experience. Listening to their stories, I quickly learned that identifying with them was not difficult at all, and I now have greater confidence that I’ll be able to empathize with my future patients as well.
Learning about addiction is helpful for medical students not just because it allows us to better care for patients. I realized during my internship that medical students also need to be aware of addiction because our environment can make us more susceptible to it. During medical school, we are isolated from our peers, pulled from our families, placed in a tremendously competitive environment and sometimes forced to sacrifice sleep.
When you look at the risk factors that make an individual vulnerable to drinking, drugs and addiction—such as stress, anxiety and high-pressure situations—medical students max out in each category. My internship not only opened my eyes when it came to working with patients suffering from addiction, but also taught me the importance of self-care.
During the internship, a few other medical students and I were immersed in Betty Ford’s inpatient treatment program. We followed a group of patients from sunrise to sunset. The treatment center offers 30-day, 60-day and 90-day treatment plans. The length of stay depends on the patient’s need, profession and financial means.
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A typical day started with morning meditation followed by group activities, such as exercising or writing. Students attended these sessions and also ate meals with patients and sat in on group therapy meetings, during which patients might talk about childhood, family and personal issues. To further the students’ education on addiction, each day physicians and treatment center staff gave lectures on topics such as pharmacology, hepatic dysfunction and psychology.
‘A perfect fit’
Much of what students learn during their first and second years of medical school never really hits home until we see a patient living with an illness we have only tried to memorize the properties of. Being in class and reading about addiction, neuropharmacology and neuroplasticity was helpful, but when I sat down with Betty Ford patients person-to-person, I fully understood how much I still had to learn. As a future osteopathic physician, I want to remember that no matter how many years I spend in a classroom, the patient will always teach me more than I could ever imagine.
Regardless of which field of medicine one chooses, patients struggling with addiction will probably turn to you, their doctor, for help. And physicians sometimes need to recognize when a patient is in crisis but won’t ask for assistance. Addiction is a disease that dramatically alters afflicted individuals and takes a wrecking ball to their whole lives. It affects an individual’s family, friends and community.
I would strongly encourage every osteopathic student to pursue the Betty Ford Center’s internship program next summer. Since 1988, the program has graduated almost 3,000 future doctors.
The lessons I learned during my time at the center will no doubt make me a more complete and holistic physician. The osteopathic approach to patient management and overall health is a perfect fit for the field of addiction medicine. To help an addict is to help the entirety of a person. What could be more osteopathic?
Shawn A. Silver, OMS II, attends the Michigan State University College of Osteopathic Medicine in East Lansing and is a member of the American Society of Addiction Medicine.