Bharat Sanders sheds light on how patient-centered medical education put him behind the eyes of the patient and fundamentally changed the way he practices medicine.
I walked through the empty halls of the hospital on the morning of my patient’s mastectomy. I was hyper-aware and, for the first time, noticed the gentle hum of the building’s inner workings, feeling my every step in my sweaty surgical shoes. I passed several banners spelling out the values of this hospital which I had seen so many times in the past, but only today did the words fully register in my mind. “Compassion is our core.” “Service is our calling.” “Commitment is our promise.” Many days in medical school had felt like a monotonous exercise of mental stamina. But today, these words deeply resonated with me and reminded me of my sense of purpose. Because today, I would play a role in my patient’s healing process.
It started with my patient; let’s call her C. She was in her late 40s and had no family history of breast cancer.
She didn’t remember me on this day. When we had first met, weeks earlier, I was simply another white coat pestering her with a litany of questions. She was likely still reeling from her recent breast cancer diagnosis and the upcoming chemotherapy to shrink the tumor. If she noticed me at all, she was probably annoyed that a lowly medical student was prolonging her time in the hospital. She just wanted to see the surgeon and return home as quickly as possible, to any semblance of normality, at a time when reality seemed to be slipping through her fingers.
I recognized her immediately when I saw her in my clinic for a hospital follow-up and chronic disease management. My family medicine clerkship site, a federally qualified health center, served as a safety net clinic for our community’s Medicaid and uninsured patients. Patients coming into this busy clinic would generally see a different physician or midlevel provider on each visit, depending on availability, making longitudinal patient follow-up complex and disjointed.
I walked into C’s room knowing that my work-up, be what it may, was likely going to be the most thorough care that she would receive that day. Despite the new and ever-present masks interfering with our interpersonal connection, I still recognized her by her tired eyes and the way she sat with the heaviness of her diagnosis hanging over her. I reintroduced myself to her and her sister, reminding them that I was there for her hospital visit. Her sister remembered me first, then remarked on how they had seen so many doctors recently that it was all becoming a blur.
At that moment, I felt a surge of empathy for C. Here she was struggling with what was likely the most stressful challenge in her life so far, with nobody to truly guide her through the confusing intricacies of her upcoming journey.
I wanted to walk with her through her illness and recovery, see the medical system and its flaws through her eyes, and advocate for her as best I could. I got permission from C and my school’s administration to be her unofficial “patient advocate” along her breast cancer journey. I was inspired by a few of my mentors who had done something similar during their clerkships. She and her sister were grateful for my interest in her well-being and promised to keep me in the loop on upcoming treatments and appointments.
Over the next few months, I saw health care through C’s eyes. I witnessed her anxiety while waiting for hours on an infusion bay, followed by overwhelming nausea, fatigue, and general malaise that carried on for weeks.
I saw her hope rise before each appointment with her oncologist as she waited for a report of a decrease in tumor size and the sense of despair that set in when her implant port had become clogged and needed to be replaced.
I understood what she felt like when she entered the hospital expecting to get her last chemotherapy infusion right before the holidays only to find out that her oncologist recently received a diagnosis of COVID-19. I felt her sense of dread as she wondered how long the pandemic would delay her treatment plan and how that would affect the tumor’s growth.
I saw what it meant for her to cling to the few good things in life—her family, the nurses who kept her comfortable during the mindless hours in the infusion bay, and even the medical student who answered her questions and continued to cheer her on as she moved toward healing. When the interdisciplinary tumor board team decided that her tumor had withered to the point where it could be excised, I said a silent prayer of gratitude. This was the light at the end of the tunnel for C.
There I was, walking toward the operating room, running the surgical videos I had watched the night prior through my head over and over so I would know exactly what to expect during her procedure. Yes, I had always cared about my patients—so many of us embark on a career in medicine because of the classic combination of a love for science and an empathetic heart for patients who need help. But today, I had truly gone to the mat for C because I felt responsible for the quality of her care. Though I would likely only be retracting and suctioning for my preceptor in the surgical suite, I wanted to do the best retraction and suction that a medical student had ever done, as if my patient’s life depended on it.
I stopped by to greet C when she was being prepared for surgery. I held her hand and answered her questions. I informed her anesthesiologist of her complaints of constipation so they would be aware when managing her postoperative care. I’d like to think I saw C’s shoulders relax a little when she saw me before her surgery. I was a familiar face in a frightening place.
A few weeks after her mastectomy, I visited C again at her follow-up radiation appointment. I noticed she was sitting up straighter and there was a new brightness in her eyes. I knew her well enough now to see that hope had returned to her life.
We talked about how things were going. When she pulled off her hat to show me her new hair growth, I grinned from ear to ear. All of the medical appointments and struggles so far had been worth it—remission was in sight! That day, I saw the joys of health care through her eyes too, and I was very grateful for her.
Wouldn’t it be incredible to carry this sense of personal responsibility to every patient interaction we have? Just imagine the improvement in the quality of care of our patients if we took ownership over their health outcomes. It may sound like extra work, but I truly believe that this depth of connection to our patients will help us prevent physician burnout.
As medical students, we often allow our clinical education to be something that “happens to us,” often coming home from rotations exhausted by the dichotomy of either terror-induced adrenaline or mind-numbing shadowing. We fulfill requirements set forth by the Liaison Committee on Medical Education and our medical schools, and we want to run out of clinic early so that we can study harder for the next shelf or board exam.
I want to transform that narrative. We as medical students have the power to fully engage in our clinical education, which begins with taking responsibility for our patients today.
How do we exemplify this in modern-day medical education that is primarily focused on quantitative outcomes, transitioning care, and shift-based work? How about when the longest longitudinal relationship we will have with a patient during clerkships is likely a weeklong hospital stay?
Medical schools must adopt a new modality of learning, one that allows students to engage in health care through the eyes of the patient through the use of continuity clinics and integrated clinical clerkships. This method of education helps us as students not only recenter our efforts on the patient but also enrich our knowledge acquisition by tying our learning to patients we grow to care about, creating a new generation of more empathetic physicians.
Patient-centered medical education put me behind the eyes of the patient and will fundamentally change the way I practice medicine. As the legendary Francis W. Peabody, MD, said, “The secret of the care of the patient is in caring for the patient.”
Bharat Sanders: Codirector of the Student Taskforce on ACEs and Resilience, and Fourth-Year Medical Student, at Georgia Institute of Technology