Healing through trust

When I was a caregiver at an assisted living facility, there was a resident, Imogene, who would bellow at every worker, “I can’t hear, I can’t see, I can’t speak.” As I helped Imogene in her room, I would stop by her bed, and ask if there was anything I could do for her and her response was always “No!” After a couple of weeks of the same routine, she finally stopped yelling at me, but remained wary.

One day I asked about the teddy bear she clutched. She told me that she missed her son, who gave her the bear. I took the opportunity to ask her more questions, since she was finally willing to talk to me. Imogene told me that she used to live in Austria, and that her son took her to operas. It didn’t take much time or effort on my part – but the genuine interest I showed Imogene, changed our relationship.

Every time I entered the room, Imogene’s face would brighten, she would smile, and speak to me about her life in Austria – I believe she finally trusted me more, which let me provide better care for her.

Before starting medical school – during my time as a caregiver – I valued listening to patients’ stories because I knew it established mutual trust. I suppose I thought that practicing medicine would be like my time as a caregiver. But, it hasn’t taken me long to see that doctors do not always provide empathetic care that prioritizes patients. Patients want to trust their doctors and know their doctors are formulating plans that best adhere to their wishes. Understanding a person’s background can help doctors treat patients in a way that is better for that individual. Even if people have the same disease, their illnesses manifest differently, and therefore, each patient should be treated as a unique case.

Some may argue that complex emotional conversations with patients are not worth a doctor’s time and that social workers or nurses could spend time dealing with patients and their suffering. However, I believe doctors have the responsibility to take the time to have difficult conversations with their patients.

A doctor’s words and actions hold significance to patients. Patients tend to cling to every meeting with the doctor and analyze all aspects of their interactions. They assign more power and authority to what doctors say, over others – because doctors are the experts.ⁱ Therefore, doctors need to be willing to bring up difficult conversations with patients rather than relying on others on the medical team, because the patients trust them.

As a first-year medical student, I had the opportunity to participate in an “Early Hospital Experience.” I was caught off guard by some of the realities of medicine that I witnessed: we spent most of our time discussing patients rather than spending time with them since the attending preferred to keep rounds to thirty minutes. I now realize how easily doctors can become detached from patients and jaded; that what I’ve been learning in my longitudinal humanities curriculum might be lost once I start clinical practice.

I can’t understand how medical students (who typically enter the field full of empathy) lose this part of themselves throughout training. I wonder how we can genuinely connect with patients to establish trust, despite the health care system prioritizing efficiency and productivity. This is where I believe the medical humanities has the capability to help future doctors provide better patient care – because it underscores that medicine is inherently interpersonal.¹

My experiences and my introduction to medical humanities have made me passionate about integrating these concepts into patient interactions. I founded my school’s medical humanities club to reiterate that we should provide holistic patient care, take time to reflect, and address the detachment I witnessed.

The club creates a space outside of the curriculum for students to engage and discuss these concepts without the pressure of grades. Sometimes reflection, like remembering what initially drew you to medicine, can reinvigorate doctors to engage their patients in authentic conversations about the realities of illness and suffering.

My hope is that by creating this space to have these conversations, my peers and I will become the kinds of doctors I hoped to encounter during my Early Hospital Experience that will take the time to connect with patients.

Clarice Douille is a second-year medical student at the Creighton University Health Sciences Campus in Phoenix, Arizona. Douille earned her BS in Biological Sciences from the University of California, Santa Barbara. She is interested in implementing the medical humanities into her future clinical practice. In her spare time, Douille enjoys the challenges of sudoku puzzles and is an avid rower.

References:

1. Piemonte N. Afflicted: How Vulnerability Can Heal Medical Education and Practice. MIT Press; 2018.