The loudest sound I heard was neither the punctuated laughter of youthful teenagers nor the whispered voices of lovers holding hands — it was the wind.
And I could feel it, too. I pulled my blue hat further down over my ears. Sheepishly, I looked around to see if anyone else was struggling against the Scottish gales.
Clutching onto the ground with my hands at precarious points of the climb, I trekked over the rocky terrain of Holyrood Park and rose 251 meters above Edinburgh. My pink-and-white Converse shoes became stained with mud, as did the folds of my black pants right around my ankles. I was out of breath. It was February, and hidden patches of ice made me nearly slip, but an outstretched hand from a fellow hiker always pulled me back up. And then, at long last, I finally did make it to the top of this extinct-volcano-turned-mountain. When I gazed at the strokes of gold and orange painting the sky, and stood in silence with the rest of the hikers, contemplating the vastness of the landscape with awe, I realized my ethnography course would teach me more from beyond the walls of our classroom than it would ever indoors.
Studying abroad in Scotland enriched my medical education in more ways than one. I learned to try new things, even if there was a chance of failing. Besides letting my taste buds explore the famous cuisine of haggis, discovering how to dance in a ceilidh and gradually acquiring the local lingo, one of the other “new things” I tried was ethnography.
This is the study and systematic recording of human cultures. Or, as my professor put it, “deep hanging out.” During the semester, we would not only learn about the theory of ethnographic fieldwork, but we would also carry it out in practice. At the heart of the course was a collaborative project in which we applied the qualitative methods we learned in lectures to our experiences out in the real world. My team chose a hillwalking group in Edinburgh, and we were commissioned to observe, participate and “hang out.”
I hadn’t done anything like this before.
My eyes and ears were trained in new ways. As I got to know the hillwalkers more, I recorded notes on different facets of the group, from its history to the members’ varying personalities to the types of clothes they wore. During our hikes, I also documented my analysis of the terrain, the climate and the relationship between the places we walked and the people who walked them. Through this practice of broad observation, ethnography reminded me of the importance of holistic study.
So, too, it is with medicine. Physicians need to record their patients’ medical histories (both personal and familial), the different environments they live and work in and look at their patients holistically in order to make more informed diagnoses and treatment options. We need to analyze the whole person, taking into account mental and social factors, rather than just addressing the physical symptoms of a disease.
Paired with this focus on the whole was a need to pay attention to the equally important minutia. Ethnography involves both active listening and contextual interpretation. To forge a better understanding of situations, I had to see the little details while keeping in mind the bigger picture. Similar methods are employed within medicine as physicians listen to, empathize with and evaluate patients’ stories.
Lastly, I had to learn how to establish rapport, not only with my group members, but more so with the hillwalkers we were observing and interviewing. I decided to attend weekly hikes to get to know the members better and to show them that I was genuinely curious about them. As we communicated our thoughts and discussed our beliefs, I could not ignore what an integral part listening played in the interactions that connect us to strangers. Likewise, we need to build trust with our patients, and most often, a well-intentioned heart and willing ears are the best tools.
Ethnography challenged me to step outside my own world and to enter another’s. That is what we will do as physicians, too. These are some of the lessons I learned from ethnography, and in the future, when I walk into the clinic, these are the lessons that I will carry with me, reminding me to always pursue a more profound understanding of others and to walk in a deeper knowledge of the human experience.
Editor’s note: The author is a student in The Program in Liberal Medical Education, an eight-year continuous medical program at Brown University.