As a third-year medical student, I am confronted daily with my own ignorance. Often, while talking with patients, the diagnostic decision tree can spiral away from me becoming an abysmal labyrinth leaving me feeling at best, inspired to learn and, at worst, inadequate. Missed connections constantly remind me that in becoming the best physician I can be, there is still so much more to learn. But what if instead of backing away from the unknown, I stayed there with my patients? What if I could use these moments as opportunities to practice something much deeper and more timeless than simply discovering areas I need to study?
It started during my first week of clinical rotations while talking to a forty-year old man who had already suffered multiple heart attacks from illicit drug use. His symptoms piled up, and the decision tree became more complex with each exchange. A moment came when he told me that he had been drug-free for six months. Suddenly, the labyrinth disappeared leaving me disarmed from my detective role. I was overtaken with a sense of presence when judgments and even thoughts themselves dropped from my consciousness. From this state, I set aside medical knowledge and expressed genuine admiration for his important accomplishment. It seemed as though a heavy weight of shame lifted off his shoulders as he visibly relaxed for the first time. Soon after, my attending physician joined us, piling on more questions, rebuilding the labyrinth, exposing what I had missed and highlighting the areas that I needed to study.
Later that night, in study and reflection, I found myself filling in these gaps of knowledge, attempting to untangle the intricacies of my patients and trying to make sense of their signs and symptoms. However, my mind kept returning to the patient I had encountered earlier that day. I experienced this subtle feeling that something important had happened. I became curious about the man and his story, but above all, I wondered what the most important part of that appointment had been.
Then, about a week later, it happened again. This time, it was the fatigue of a seventy-nine year old man, which carried with it an inherently long differential diagnosis. As the interview progressed, I felt it coming again: the dead ends, the unknowns and the labyrinth returning. In perhaps my naiveté, I made a bold suggestion that his fatigue, which was triggered by chopping wood, could simply be a sign of his body slowing down from aging. These authentic moments have a way of slicing through encounters and exposing the heavy truth that we so often dance around quietly.
It was his reaction that again disarmed me. He began speaking with great pride about his pastime of splitting wood, his unwavering work-ethic and his determination to continue living life on his terms. His fatigue was not disabling, and, deep down, I think we both knew he was pushing himself too hard. Our conversation pushed the medical questionnaire right into therapeutic territory. As I sat with him in mere presence, I allowed him to speak openly about his story and symptoms. And that’s when it clicked: Hidden behind every unknown and bundled within every patient interaction is an opportunity to practice deep presence and empathy.
I’m not suggesting clinical knowledge is unimportant. As a third-year medical student, I am repeatedly thrown into new environments where I am tasked with integrating two years of didactic knowledge into my patients’ lives. It’s a tremendous undertaking, but too often, the focus stops there. This is a shame because research has shown that both empathy and presence are skills to be refined rather than just innate qualities. These are skills capable of growth, and they undoubtedly lead to better patient outcomes. During our third-year of medical school as we begin rotations in the clinical setting, we are in the ideal environment to begin the noble pursuit of these practices.
As our careers progress, the practice of medicine will continue to be shaped by new and unforeseen forces. Impending technologies like artificial intelligence (AI) with its exponential growth are almost certain to radically disrupt healthcare in the next generation. As more data interpretation and science begin to be outsourced to AI, what skills will be absolute premiums for the physician of the future in the art of medicine?
For two years, I was not aware of this question as medical school conditioned all of us to see patients as constellations of signs, symptoms and lab values. This pattern recognition, now applied to real patients, is a skill I hope to master. But our work requires more than this. Third year has introduced me to the idea that power exists in the white coat, in making a genuine connection with patients and just being present with them.
So every day I practice meditation, which is an activity known to enhance presence and empathy. I carry this practice into patients’ rooms along with my questions and stethoscope constantly striving to perfect these tools. As third year marches on, my increasing medical knowledge results in hesitancy becoming less and less frequent; however, medicine is not yet a perfect science. There will never be a point in my career when I know everything, and the labyrinth does not come spiraling back during some unique patient presentation. In those moments, my patients will require something more than medical knowledge itself. It is then I hope to remember this truth: amidst the unknown, our patients represent opportunities to practice the timeless skills of empathy and simply being present with them.