To the Editor:
As a faculty member in an urban academic medical center, I have had the opportunity to get to know students and residents on a professional and personal level. I learn of their motivations to pursue a career in medicine, their paths, their experiences, and their fears. I have observed that case-based discussions and problem-based learning have improved deductive reasoning skills beyond what I learned from traditional classroom teaching. However, with less time spent in the hospital, I have noticed among learners a rising discomfort with ambiguity and increasing difficulty understanding the importance of individualized care. There is less time to re-evaluate, to observe, to reflect, to discuss. Time is in short supply; perhaps learners would benefit from time and experience in customer service to develop hands-on skills that they need.
How do we care for the adolescent girl with poorly controlled diabetes mellitus who refuses to inject subcutaneous insulin? What about the homeless man with lung cancer who does not know when his next meal will be? How do we help the socially-isolated mother, estranged from her children, who is struggling with depression and drug addiction and declines help? What about the young man with paraplegia and repeated hospitalizations for urinary tract infections who physically and verbally threatens anyone who enters his room? Our patients require creative solutions and the compassion of clinicians with open minds and practical wisdom.1
I recently worked with a resident with the ability to see the big picture and individualize management plans. He caught the nuance of each interaction and the dynamics amongst family members. He tried to understand their social circumstances and financial restrictions. When a patient became angry, combative, or accusatory, he did not become angry in return. Instead, he tried to understand the reason behind the anger. During a feedback session, he explained that, more than any class or rotation during medical school, his four years as a bartender helped him understand the importance of improvisation and maturity.
Perhaps all medical students should spend one month working in a customer service position—in retail stores, restaurants, amusement parks—to learn practical knowledge, to reflect upon specific interactions, and to learn by process. Being a physician is not an occupation based purely on customer service; however, through these experiences we learn the art of listening, compromise, and improvisation. Only after understanding the motivations, paths, experiences, and fears of our patients can therapeutic relationships flourish and grow.
Cynthia H. Ho, MD
Assistant professor of clinical medicine and pediatrics, Departments of Internal Medicine and Pediatrics, Los Angeles County + University of Southern California Medical Center, Keck School of Medicine, Los Angeles, California; email@example.com.
1. Kumagai AK. From competencies to human interests: ways of knowing and understanding in medical education. Acad Med. 2014;89:978–983