The best thing about clinical rotations

Morning rounds begin the way they always do: We sit around a small table at 7 a.m. The doctors look over the list of patients, some well-known to this hospital. They exchange stories while I groggily sip my coffee, jotting down notes on the patients I’ll be seeing that day.

This time the usual “gallows humor” takes a dark turn. The physicians are frustrated with some departments, with management, with life in general. Their concerns are understandable and certainly affect their own lives and the lives of their patients.

The attending interjects, “if you lose empathy, you might as well be working at Amazon.” His tone tells me he’s pointing out the merits of direct patient care, which can’t be addressed simply by attending to discrete data points or automated medicine.

It’s an interesting, somewhat philosophical statement, given the coarse hospital talk the group normally entertains.

A familiar, hallmark term

As a fourth-year medical student, I’m happy to hear that familiar, hallmark term of our preclinical years: empathy.

In the first two years of medical school, empathy is a cornerstone of our education. We are tested on empathy during our simulated patient encounters. Real people, playing our patients, evaluate us on our ability to convey empathy while we listen to their chief complaint and investigate their presenting illness.

But how do we cultivate it in the setting of high-volume, high-stress patient care? I decided to ask my attending.

“Brute force,” he answers, hurriedly.

He dashes out of the room and calls back “self-care and work-life balance,” catchphrases I have heard before. But I’m wondering how well those work when the stresses of the job keep mounting?

One of the keys, as discussed by other hospitalists, is practicing bedside manner and always including a physical exam. Many physicians of internal medicine attest to the importance of connecting with patients, both for patient and physician wellbeing.

The human connection

As one physician put it to me recently, you can manage your patients from the computer screen, seeing their vitals and lab results and treating them without ever stepping into the patient’s room. But what is lost is the human connection and the measurably improved outcomes for patients who receive care they perceive as personal and empathetic.

Fortunately, personal, empathic care is readily accessible to third- and fourth-year students who have the privilege of spending more time with each patient. I’m aware of how our empathy can be eroded by the stresses of clinical care settings, but right now, I’m trying to practice connecting with patients as much as I possibly can.

One day on the hospital floor we have a particularly difficult patient: experiencing homelessness, polysubstance drug abuse, verbally abusive, and resistant to staff efforts to assist him.

He’s not one of the patients I’ve been assigned to, but he has a wound vac on and I’ve never seen one before. As a medical student, the hospital is our classroom.

I knock before entering the patient’s room. He wants his pain meds, but they’re not scheduled for another half hour. He’s hungry, but he’s NPO because he has an upcoming surgery. And his withdrawal likely makes tolerating all of these discomforts harder.

With his consent, I look at the wound, with the wound vac pumping out fluid. He’s beginning to get more irritable and I feel sorry that I can neither give him pain meds nor anything to eat or drink.

A little conversation

So I take a different approach: I ask him where he’s from and what it’s like there. We talk about the rainforest where he grew up. With a little conversation, his irritability settles. As I’m leaving, he says, “thank you for talking to me.”

I hope our conversation stayed with him as he prepared for surgery. I hope he was reminded that he is so much more than his diagnosis, than any one of the innumerable identities that might be ascribed to him in his medical record.

My attending was right. Without empathy, we might as well all be working behind computers, plugging in numbers and letting automation supersede direct patient care. I’m grateful to have protected moments interacting with patients. These moments are teaching me the importance of treating the whole person and ensuring the wellbeing of patients and medical staff.

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