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Teaching and Learning Moments

Reflections on a New Curriculum

Eyrich, Nicholas W. MS

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doi: 10.1097/ACM.0000000000002856
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Dust settled through the late September afternoon, with blood orange rays of sun sliding diagonally through the living room window. The dust had been kicked up by children racing in between moving boxes stacked like skyscrapers in their own pretend city. The new house meant new hiding places, new neighborhood kids to play with, and new windows for the family dog to bark from protectively. I shook J.M.’s hand and took a seat at the dining room table. As he apologized for the clutter around us, I felt an uplifting sense of youthful innocence in the air. The feeling was blindsided and sunk by one realization: His kids knew they had moved because their dad needed to be closer to the hospital.

He told me everything. More than a decade of every type of imaginable pain from a myriad of chronic comorbidities was shared with a complete stranger. I could feel his voice shaking when detailing particularly difficult times, and the same voice deepening with strength as he worked to suppress the tears brewing just underneath his eyelids. From emergency room visits to expert referrals, from medication trials to being told it was all in his head, a common theme emerged over the years: a surplus of symptoms and a scarcity of answers. He opened his personal life and shared the medical challenges in a way I had never believed possible. I stared down at the glass of ice water in my hands, desperately hoping the right thing to say would somehow appear in the tiny bubbles frozen in the ice cubes. What could I do? What could I say? This was only my first week of medical school, and the expected textbooks and lecture slides were nowhere to be found. So, I did the only thing I knew how to do. I listened.

Fourteen months into medical school, on the first day of the family medicine clerkship, I saw J.M.’s name on my patient list for the afternoon. Flashbacks of the tearful conversation about debilitating pain and frustration from unanswered questions came to me as I was about to knock on the door to the room. I paused, knocked twice, and entered the clinic room, where I was met by a tired but welcoming smile from J.M. Although I had not had much to offer at our initial home encounter, absorbing details of his medical history, symptoms that caused him trouble, and his personal aspirations and career plans helped to build rapport and cultivate trust in the clinical setting. He knew how early I was in my training. He knew I would not have answers to all of his questions, but he still had faith that I was on his team. Sharing the intimate and emotional details of his life in the past and feeling truly heard made for the type of human connection you cannot find in textbooks.

So, we talked. The standard set of patient questions quickly flowed into a more natural conversation. He was eager to share his progress, and his children chimed in with their own updates throughout the visit. We shared so much in a short period of time, and before I knew it, I was back in the team room writing up my clinical note. My erratic typing was interrupted by the sudden realization that in just over a year, I had gone from asking about this man’s health to playing a direct role in his care. Our former visit allowed me to look at the current one through a more compassionate and holistic lens. I have heard that doctors have one moment in their training that sticks out, a moment when they feel like a real medical provider for the first time, sometimes through an amalgamation of different experiences. Such raw, career-shaping experiences are certainly multidimensional, without a score or percentile to their name. Early clinical immersion pushes us to grow as compassionate caregivers and provides us with the experiences to cling to when challenges arise in the future—invaluable lessons in what it means to be truly present with a patient and how that fosters rapport building and patients’ buy-in regarding their own health. Most of all, this experience introduced me to the beauty of having a patient feel genuinely cared for, which will undoubtedly guide my practice of medicine in years to come.

I had my first “This must be what it’s all about” clinical moment just over a year into medical school. The emotions that were precipitated by meeting and then caring for J.M. will remain with me moving forward because for the very first time, not only did I feel like a doctor, I felt like somebody’s doctor.

Copyright © 2019 by the Association of American Medical Colleges