The heart monitor beeped incessantly, and the pulse oximeter kept dropping to the 80s. I ran to get a nurse. He walked calmly into the room, straightened the patient’s finger and left without a word. The oxygen went back up to 98.
I no longer feel alone the way that I did the first few weeks of dissections, because now I recognize that my peers were sectioned off at their tables also worried that they were losing their sensitivity, that they weren’t good enough to belong, and they didn’t know how to cut into a person. I wish that I had known what my classmates were thinking and feeling during the anatomy course.
To understand the issue surrounding assessments, we must understand that it has become increasingly challenging to train physicians suited to face contemporary changes. To future physicians who have access to a repository of ever-expanding information on their smartphones, being tested on ‘high-yield’ minutia serves little purpose. Being able to think critically (and perhaps even imaginatively) in order to make sense of that information for patient care is what counts. And thus, no matter how standardized an examination is, lack of contextual reference renders it futile.
Why would someone choose to donate their body to medical education? We have a dishonorable history in medicine of illicitly sourcing cadavers for dissection: robbing corpses from graves, murdering people for their bodies and salvaging the unclaimed dead from city hospitals and morgues. Today, we call the bodies we learn from “donors” instead of “cadavers” to honor their autonomy and personhood, their choice to be in the room.
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 twenty-six 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. But right now, no one makes a sound. There is no buzzing of saws, whirring of the suction machine, or gentle clinking of hemostats and Metzenbaum scissors against the metal tables, no nervous laughter, exclamations of discovery or confused mumblings.
Another day passed as I approached the deadline of my latest assignment. Our professor asked students rotating in the ICU to reflect and write up a patient encounter that influenced them deeply. In an effort to encourage a more humane and nuanced understanding of medicine, this was part of a series of reflective assignments being introduced in medical schools. While the budding writer in me was delighted at this prospect, the medical student, ironically, was …
I believe these inadequate approaches circumvent the answer the interviewer is actually trying to provoke: are you self-aware enough to know your faults?
Every one of us is imperfect, fallible, and vulnerable to making mistakes. Being a strong physician requires self-reflection and awareness, and interviewers want to know if you are willing to be honest with yourself and others. I can’t tell you how to answer this question, but I can tell you how I did.
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 healthcare 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.
Over the next four weeks, I will share a series of essays with you in which I tell some of those stories. This writing results from the work of a summer, supported by a Summer Research Fellowship in Medical Humanities & Bioethics at the University of Rochester School of Medicine and Dentistry, in which I interviewed nine first-year medical students, two third-year medical students, eight anatomy and medical humanities professors, two Anatomical Gift Program staff, three palliative care clinicians, two preregistered donors and one donor’s family member. Out of respect for their privacy, none of the people interviewed are named, and identifying characteristics have been removed.
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.