Professionalism CEO 6.1: Consistently demonstrate compassion, respect, honesty, integrity, accountability, altruism, prudence, social justice and a commitment to excellence in all professional and personal responsibilities.
When I decided that I wanted to become a doctor, I was often cautioned to expect a long and hard road ahead of me. I think everyone knows that a career in medicine is difficult, but I doubt that one truly can truly how it is difficult without experiencing it first-hand. I was frequently warned about the demanding workload and complex material that I would need to master to survive medical school. Not mentioned were the non-medical skills that complemented medical knowledge to provide optimal medical care.
As part of our pre-clinical curriculum, we attended weekly small groups called Longitudinal Group, otherwise known as LG. Each LG consisted of approximately 15 students paired with a facilitator who was an attending physician. LG focused on skills and traits that allow us to be more effective physicians beyond medical knowledge. These skills include how to take a patient history, the physical exam, how to collaborate with other healthcare professionals, and how to converse with patients. My classmates and I worked together and practiced on each other.
We were then tested on our ability to combine medical knowledge with communication and professionalism through Objective Structured Clinical Examinations (OSCEs). Each OSCE consisted of 3-4 clinical scenarios. Prior to entering the room for each case, we are given the patient’s chief complaint and vital signs. We are expected to conduct a full patient interview, obtain the relevant history, and perform a physical exam.
At first, I felt incredibly awkward asking questions about their bowel habits or sexual history. I wasn’t sure how to proceed when a standoffish standardized patient gave one-word answers to my questions and stared me down as he waited for me to fix his problem. Fortunately, with practice, I became comfortable with asking any question necessary to care for my patient. My standardized patients praised me on my professionalism and empathy, and I received similar feedback as I advanced into my clinical clerkships.
During my Sub-I rotation in general cardiology, my team took care of a patient who came in due to exacerbation of heart failure but quickly decompensated and ultimately required a dopamine drip to maintain his heart function. All attempts to wean the dopamine failed. The patient’s fiancée and children were understandably upset and confused. Their understanding at the time of admission was that he would be discharged after a few days of diuresis and medication optimization. How did everything go so wrong so quickly?
One evening, when I was working the night shift with a resident, the patient’s nurse called and informed us that the patient’s family wanted to speak with someone regarding his prognosis. Since I had worked with this patient extensively while serving on the day shift, I asked my resident for the opportunity to lead the conversation, and he agreed.
Medicine is a career many of us pursue because we want to provide care to patients that ultimately betters their lives. Rarely do we consider that there will be times we fail at this goal. No amount of practice with fellow students or standardized patients could have prepared me to speak with a woman about how her unconscious fiancé was barely being kept alive by a temporizing medication that would soon lose its effect within the next few days. I was worried that she might have questions about his medical management that I would not know how to answer, or that she might be offended a lowly medical student was being sent in to speak with her. This was ultimately not the case at all.
The patient’s fiancé and children’s questions were relatively straightforward (“what is currently being done for him,” “what can we expect over the next few days,” “is there anything that we need to do,”), and I was able to answer most of them with the help of my resident who supervised. Most of the time was actually spent discussing their expectations and feelings throughout the entire process. They didn’t need an expert in cardiovascular medicine to give a lecture on the background and treatment of congestive heart failure. They wanted someone to talk to and listen to their concerns and emotions through an incredibly difficult time.
We as (soon-to-be) physicians look forward to the times we can give our patients good news about their disease. No one enjoys telling a patient or their family that the patient is dying, but it is a task and skill that we must master for the sake of our patients. Medicine is not simply about preventing death, but also about maximizing life. A cancer patient with a life expectancy of 3 months still has those 3 months to live, and it is our duty as physicians to help these patients understand their goals of life and care and how to best achieve them. I will think of him as I continue on in my medical training, and I will never forget how honored I felt that my patient and his family allowed and trusted me to be a part of his care.