and now, has been to break barriers in patient care and connect with patients in a therapeutic alliance to optimize their health. In less than a year as a resident physician, I have learned a profound amount of medicine, but perhaps more about myself and about patient care. What’s more, I have learned a new context of being human that patients and physicians alike should keep at the forefront of their interactions with one another.

I have been humbled to work with the Veteran population in my training. Although not a stranger to this community, having active duty and retired military family members, I found myself learning more about what exactly it means to be human and the importance of building rapport. As we say in medicine, a patient’s pathology does not “read the textbook” and, in that regard, no two patients can be treated alike or approached in the same way. I learned this lesson when working with a patient who was suffering from the long-term effects of PTSD and a traumatic brain injury. Struggling with chronic lower extremity pain, this patient frequently came to the clinic due to insistence that they had a deep venous thrombosis, despite extensive imaging ruling this pathology out. “If I do not have a blood clot, then what is this?” my patient asked, pointing clearly at superficial varicosities on the calf. Relaying information and reassuring this patient that neither anticoagulation nor vasodilators would solve their lower extremity pain was simply not the same as telling another patient similar information due to this patient’s unique culmination of experiences. This patient did not understand the extent of my training, compassion, or well intention for their medical care. Perhaps I failed to understand the extent of their pain that was lost in a fixed, false belief. Increasingly frustrated, my patient ultimately asked for a new physician and while I am certain they do not have a blood clot, I often grieve over my failure to bridge that therapeutic alliance and reassure them otherwise.

The culmination of various patient experiences ultimately redefined my approach to patient care. To that end, my message is simple and succinct—as physicians, we are only human. We will unfortunately overlook data, fail to connect with patients, miss diagnoses, and commit errors, though the delineation is that good physicians will learn from these mistakes and allow them to inform their future practices, for better or worse. According to the National Academies of Sciences, Engineering and Medicine in a landmark report1 from 2015, “Most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.” To that end, physicians are often held to a higher standard than the rest of the community due to our unparalleled training and because we deal every day with our most valuable asset: health. Despite this, adherence to physician recommendations continues to be a worldwide issue as well as often a multifactorial issue, according to the World Health Organization (WHO). Unfortunately, only 50% of patients are adherent to long-term therapies in developed countries, according to the WHO.2 While physicians are expected to be superhuman and perform free of error, sometimes our recommendations, efforts, and sacrifice go without recognition.

The solution? I believe it lies in communication, transparency, and remaining fundamentally human. While I approached my intern year with the mindset to just be approachable and an advocate for patients I encounter, I found a new meaning and relief in those instances where I realize I am no different than some of my patients. In return, I hope that patients keep their physicians’ humanism in mind when forming expectations as we fight to evolve as clinicians and earn the admiration that patients often give us. Although we may not always have the answers or operate in a realm free of error, we often shed tears and grieve the same situations our patients’ families do. It is of the utmost importance to approach our work with humility and a meticulous approach to ensuring that patients know humanism is often at the foundation of our training. We must not operate in a routine devoid of emotion or be fearful of expressing these amidst immensely challenging cases. Teaching me how to perform a death exam on a patient in the middle of night during my second month of intern year, I watched as a senior resident shed a tear for a patient she had never even met before. This experience only reaffirmed my early intern year goal to “be human” and recurrently demonstrates to me the importance of connections in medicine or, as I have learned, our failures to connect. At the same time, I believe physicians may find light and hope in that very principle of just being human.

References

  1. Committee on Diagnostic Error in Health Care; Balogh, E, Miller B, Ball, eds. Board on Health Care Services, Institute of Medicine; The National Academies of Sciences, Engineering, and Medicine. Improving Diagnosis in Health Care. Washington, DC: National Academies Press, 2015.
  2. World Health Organization. Adherence to long-term therapies: Evidence for action. Sabate E, ed. https://apps.who.int/iris/handle/10665/42682. Published 2003. Accessed September 15, 2023.

Issue

Topic

Medical Education, SGIM, Wellness

Author Descriptions

Dr. Fenske (fenske@ohsu.edu) is a resident physician in internal medicine at Oregon Health and Science University in Portland, OR.

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