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Making Medical Education Transformative
By John Hardt
"But this is why I want to be a doctor.” She said it during the discussion session in her Patient Centered Medicine (PCM-3) course. Katie, a third-year Stritch student, said that she had been finishing rounds when she went to part company with the resident physician with whom she had worked that morning. Walking down the hospital corridor together, Katie moved toward the doorway of a patient room, saying “I’m going to check on Mrs. Dolan; I’ll see you tomorrow.”
Stopping mid-stride, the resident asked, “Why would you do that?” He clarified his inquiry, saying, “We can’t do anything more for her,” and added “There is nothing more for you to learn there.”
Stritch’s third-year Patient Centered Medicine course is dedicated, in part, to students reflecting upon clinical rotation experiences like this one. With faculty mentors facilitating, they consider their clinical experience against the larger question of who they are becoming—not only as physicians but also as people.
Katie told us how she had come to know Mrs. Dolan during her two-week hospital stay. Mrs. Dolan—elderly, mildly demented and suffering with multiple co-morbidities—was dying. Although admitted to the hospital acutely, she was stabilized and awaiting transfer back to her nursing home. They had struck up a friendship of sorts. Despite evidence to the contrary, Mrs. Dolan thought of Katie as her physician. She would request that Katie take her vital signs, either untrusting or unaware of the monitor above her bed displaying them. Vitals accounted for, they would visit for 10 minutes, Mrs. Dolan talking of her family and friends, her worries and her life. Katie would adjust pillows and ask her if she needed anything. She enjoyed this time and, it seemed, the same was true for Mrs. Dolan.
Reflecting on her exchange with the resident, she expressed embarrassment that the resident had questioned this use of precious time—time that could be spent learning and mastering her art. She told us of her concern that she might be entering a profession that, on account of various “efficiencies,” might discourage these basic human interactions, these acts of giving one’s time and one’s self to another human being when the time for diagnosis and treatment have long passed. And then she said, “But this is why I want to be a doctor.”
I think of this story often here at Stritch, where we honor both in word and deed a commitment to service. I also think of this story often because the resident’s question is a good one: With so much to learn and so much to do, why would this student seek out a patient she’ll probably never see again and to whom there is little, medically, left to offer? The answer is, in some respects, quite obvious. It is an act of simple kindness achieved at little cost. But, if this is true, then there is another question. Why is such a simple narrative worthy of our sustained attention at a place like Stritch?
One possible answer presents itself in our Jesuit and Catholic identity and mission as a medical school. While not an insight exclusive to the religiously minded, the story suggests something like this: If you want to become a full human being, if you want to enlarge your humanity, give yourself away. Make your life itself into a gift; place yourself, always, at the service of others. Mysteriously, one preserves a sense of self by giving one’s self away. It is a profoundly counterintuitive claim. But its roots are deep and wide. They can be found, in fact, in the third Gospel, authored by the physician-apostle, Luke: “For whosoever will save his life shall lose it: but whosoever will lose his life for my sake, the same shall save it.” (Luke 9:24). Similarly, this idea of generosity as self-constituting is a cornerstone of an Ignatian way of proceeding through life. It is, in fact, written into Saint Ignatius prayer, the Suscipe:
Take Lord, and receive all my liberty, my memory, my understanding and my entire will - all that I have and call my own. You have given it to me. To you, Lord, I return it. Everything is yours, do with it what you will. Give me your love and your grace. That is sufficient for me.
But perhaps most importantly, this insight poses an essential reminder concerning our shared work in forming physicians in the Jesuit, Catholic tradition. In an academic medical culture that quite rightly prizes acquiring personal knowledge, expertise and skill to better serve our patients, our utility as a physician acquires pride of place among the things we value. The resident’s observation, “We can’t do anything for her anymore” recognizes this reality. One’s usefulness as a skilled technician recedes in the face of a dying patient for whom “healing” is no longer an option. Perhaps even more corrosive to the soul of medical education, we are prone to reduce patients to their usefulness as our teachers — “There is nothing more for you to learn there.”— and constrain our vision of what we can offer patients to the technical expertise in which we are trained.
But there is another way. Katie’s reflection that day in PCM-3 reminds me of it. It is medical formation that values the development of skilled physicians who are also flourishing human beings, who approach their profession aware of the gossamer-thin veil that separates the ailing from the healer. Katie wanted to be in Mrs. Dolan’s company that day not only as her physician but as a person quietly facing medicine’s limits, recognizing the mystery of our shared human frailty and finitude. It is, in many respects, a model of what we often do so well here at Stritch: encourage young physicians to be “men and women for others.” Except that on this day, it was the student who was the teacher.