Bioethics Discussion Blog: Patients as Teachers: Time for Giving Thanks

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Friday, November 25, 2005

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.

6 Comments:

At Friday, November 25, 2005 8:57:00 PM, Anonymous Anonymous said...

what do u think as a med school professor ........of those who study medicine in the carribean - do u think they are less of a doctor than the students u teach.

 
At Friday, November 25, 2005 9:59:00 PM, Blogger Maurice Bernstein, M.D. said...

First of all, the students learning medicine in the Carribean or those learning in Los Angeles are as yet NOT doctors. I certainly would not think they are less of a potential doctor ("doctor-to-be") than those students in Los Angeles. If after getting their degree they pass all the exams required in the U.S. and for a California license to practice, I wouldn't look at them as "less of a doctor". Should I?? ..Maurice.

 
At Friday, November 25, 2005 11:23:00 PM, Anonymous Anonymous said...

This is an honorable answer. The reason I asked is because I am giving medical school in the carribean some serious thought, and I often hear of the stigma attached with schooling there. A lot of students from the carribean who do their clinicals in the US have been shown a lot of prejudice from US physicians they work with. I use the word prejudice in its most basic form as being judged before knowing. They seem to be judged as a lower candidate for the high calling that the US students seem to have. This is my impression of the experiences I have heard of from others. By any chance do you know how your colleagues react to these carribean educated students - either during clinicals or as a physician. I appreciate your thoughts and comments!

 
At Monday, November 28, 2005 7:10:00 PM, Blogger Maurice Bernstein, M.D. said...

I have deleted another comment by the same Anonymous who had written the previous two comments. I would like to explain why I did so. That comment, as well as the previous two, was not related to the thread of the original posting, the value of patients as teacher of medical students. I would urge my visitors to make their comments appropriate to the subject of the original post. If the visitor wishes to begin another bioethics subject, I would appreciate that the suggestion be sent e-mail to me at DoktorMo@aol.com and I will be pleased to consider it. I may then use the subject for a new posting. I think if the comments are pertinent to the original posting, both the posting and the comments will provide a more valuable resource to the visitors. ..Maurice.

 
At Wednesday, November 30, 2005 7:27:00 AM, Anonymous Bob Koepp said...

I'm not sure just how "on point" this is to the topic of learning from patients, but not a lot of stretching should be required to see the relevance.
An article in the NYT about doctors who don't seem to have much interest in communicating with their patients -- beyond issuing directives, that is.

I'm not at all sure how well the following link will work. The article is by Gina Kolata, and appears in the Nov 30 NY Times under the title "When the Doctor Is in, but You Wish He Wasn't."

http://www.nytimes.com/2005/11/30/health/30patient.html?hp&ex=1133413200&en=c8ddc0bd96c48d60&ei=5094&partner=homepage

 
At Wednesday, November 30, 2005 6:43:00 PM, Blogger Maurice Bernstein, M.D. said...

Of course, Bob, this topic is "to the point". Remember, that the teaching to doctors that patients should do is, hopefully, not just about their physical illness. It should include teaching about how doctors should behave toward patients. There should be verbal patient feedback about observed physician deficiencies. Unfortunately, most patients when upset with their physician's behavior simply don't return and there is no attempt at constructive education provided for the doctor. Try this link
for the New York Times article. ..Maurice.

 

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