Patients as Teachers: Time for Giving Thanks

During this season of the year characterized by a holiday of extending thanks, there is one class of people for whom, I think, physicians fail to recognize in this regard: their patients. And the thanksgiving is not for the patients’ contribution to the finances of the doctors. It is for their unending role as teachers to their physicians.

One may wonder about the relationship between patients and teaching. But in our world of medical care, patients actually provide two forms of teaching: passive and active. Passive teaching is one that is certainly the most common and the least recognized. It starts literally from almost the first day of medical school when the medical student faces the daunting task of dissecting their first patient (or in non-humanistic terms, their anatomic cadaver.) It is the deceased patient who provides the student with the map of the human body but also something more. The deceased, by the cold, stiff, non-breathing, non-heart beating existence of a previously live and living human creature, now in death teaches the student about the ultimate outcome of all life and the lesson: the need for respect of persons both in life and in death since even physicians share the same fate.

And then the passive teaching goes on as the students begin interviewing and later examining their real patients. I have witnessed, while facilitating first and second year medical students when they are doing this activity, first hand. Each patient with their own individual history gives their own take on their disease, the symptoms, course, response to treatment and the effect on their quality of life and goals, a lesson that cannot be simulated by any textbook. In addition, patients are often technically wiser about their disease than the student at the time and can educate the student as to the details in diagnosis and treatment.

Later, in the medical career, the physician now is practicing medicine. Practicing represent still learning. It is their patients who continue the learning process by providing the physician with their varied history and therapeutic responses to the same established diagnosis. The value of this passive teaching to the doctor who stays aware and recognizes the teaching is enormous. I believe it is for these learning moments and hours to the student and later the physician in practice from the patients themselves which deserve the thanks.

Finally, and perhaps not fully known by the public, is the developing role of patients in the active teaching of students. So-called “standardized patients”, which I have discussed on previous postings, have been in existence for medical education for a number of years. These “patients”, of course, are not really patients but are actors trained to present as patients to the students both for history taking and physical examination. As you might imagine, it is difficult indeed to find actors with physical signs of the required illness. A new trend in medical education is the use of trained genuine patients. A patient who has the disease and the physical findings can be trained how to teach the students. The patient, therefore, can speak to the student with true understanding of the pain or impact of a disease (only attempted to be simulated by the standardized patient) and also have additionally the physical finding to go with the disease. (To read more about trained patient teachers go to the following link BMJ 2002;325:818-821 ( 12 October ))

For me, as a medical school facilitator, I have personally thanked many patients for their participation with my medical students. As a physician of many years, I really never directly thanked a patient for teaching me though I recall complimenting patients as being “good patients” but unfortunately never as “good teachers”. Maybe now is the time, at least, to blog my thanks to all the patients. ..Maurice.