As the door swings open, it hits the chair that was shifted more than usual. / Next to the computer sits a 94-year-old woman in a wheelchair / who is here for one last visit.
The first thing I notice are his boots. He’s still in his street clothes, having just been admitted. He looks thin, emaciated — his clothes hang off him, shirt collar drooping down from his neck like peeling paint. His boots, however, seem to fit him properly. They look warm, well-worn but sturdy, like they have weathered a hundred bitter winters and could withstand a hundred more. For some reason, this comforts me.
I took a quick trip to Target a month ago and browsed for new jeans. I approached the clothing section and was suddenly struck by the overwhelming challenge I had undertaken. From rack to rack, I had to choose from a multitude of different brands (Levis, Wrangler, True Religion and more), different styles (skinny, bootcut, tapered and more) and different colors (blue, black, tan and more). I had to figure out my current exact size and, even then, there are many different ways to size jeans (small-medium-large, waist-by-length and others).
Upon arriving at the room, we learn that the nurse continued trying to speak to this patient in English despite the patient’s evident inability to speak the language. Following her half-hearted attempt at “patient education,” she proceeded to lift the patient’s gown and attempts to strap on the monitors. As a result, the woman is frightened by her nurse because she is unaware of what this foreign nurse is doing to her and her unborn child. One week out from detention. She is scared. Imagine.
In this episode, Peter and I put together the culmination of our first season of podcasting. We took lessons from leaders in medicine, business and the military to bring you five rules for leadership.
“We are taking him to rehab,” she said. I could hear a faint sigh of relief and happiness permeating her voice, which had been distinctly absent for the last few months. I could also hear wind whooshing in the background and a distant trail of her voice, which meant they were already on the road.
As physicians, we must work to lift patients up when they are struggling, rather than shaming them into well-being. As Dr. Donald Berwick once noted, it is not always patients’ diagnoses, but their helplessness that kills them. Indeed, the helplessness we instill through our focus on individualism and molecular pathology in the clinical setting will ensure that this epidemic kills millions prematurely and costs billions of dollars. If obesity is a disease caused by society — its inequities, trauma, and expectations — then the solution for obesity should address more than just the patient sitting in front of us.
It is the day before the first anatomy lab for the first-year medical students, and a single professor walks alone, up and down rows of tables laden with 26 naked, embalmed bodies. He silently shares a few minutes with the donors, a private thank-you. Soon the donors will be covered in white sheets, and the students will tentatively spill through the locked wooden doors of the labs, a rush of anticipation, teamwork, questions and learning.
As we seek to understand this phenomenon, there are many subjective variables that contribute to the trust between patients and providers. Measuring trust in a reliable and consistent fashion is challenging in itself. With these limitations in mind, three salient factors are involved in the decline of patient trust in physicians: one, a commodified health care system; two, lack of quality time spent with the patient; and three, racial influences on the patient-provider relationship.
When I was 17, I went to the gynecologist for a Pap smear because my mom said, “Once you have sex you have to get one.” It felt like punishment, but it was also the only way I had a chance of getting birth control. I went to three different doctors and exam after exam, they kept saying I could have cancer. I did a ‘colpo’ — whatever that is. After that, they did three different procedures on me, three, all to take pieces of my cervix. I don’t remember what they were called or what even happened. All I remember is the pain.
Regardless, with this data in mind, it is important for students in medical education to understand that we are entering the profession at a time where the reputation that precedes us is not ideal. This also means that the capacity to alter this perception is dependent on the way we practice upon entering the workforce.
There are many reasons a medical student may struggle on their obstetrics and gynecology rotation. There is an obvious lack of medical knowledge or procedural skills common in all clinical rotations. But, on OB/GYN, it can be especially challenging for male medical students to gain the confidence to feel comfortable talking about sensitive topics and being present for sensitive exams.