The author asserts that the medical student's after hours telephone management of a DVT establishes "character" and "moral"fiber. This ignores that teaching someone how to use sq lovenox is often best done in person, and in an integrated system there are pathways for acute care that may include the ER and acute care clinic. The author has an old fashioned view of the heroic individual doctor, on-call to her community 24 hours a day. That is a path to burnout, a luxurious scenario spun out by an academic physician.
As a woman in internal medicine I feel sympathy much more important than empathy. Empathy fatigue can be a source for burnout. The best nurse with whom I worked took Gallup strength finders and empathy was one of her lowest strengths while sympathy one of her highest. Great writing. Keep em coming.
Having practiced in the community for the past 30 years, I have no connection to what is going on in medical education and training. I also get the sense that Dr Rohlfsen does not really understand what medical practice in the "real world" has been like over the past 30 years and where it is currently!
What I do see is twofold - somewhere in medical education, it must be emphasized (and modeled) that the patient is the sacred center of our endeavors. Empathy in trainees should be nurtured (and, again, modeled). This means we don't view patients as "entitled" or focus on the "microagressions". We don't develop a "them vs us" sense. We need to understand and appreciate "human nature". Training programs must foster Oslerian ideals.
The other side of this (and the issue that stresses the ability to feel empathy) is the current status of medicine - and where it has been for the past 30 years. The physician is no longer "leader of the ship". Daily life in medicine is long hours, tedious decisions and tasks all day long, mainly working in isolation (not seeing or interacting with colleagues for most of your day). Being asked to do 45-60 minutes worth of mental work and clerical typing/data entry in a 15-20 minute chunk of time. Being told (by who? CMS?) what constitutes "quality" and how we must "measure" this. It seems that trainees are now taught that "routine physical exam" is no longer a necessary "thing". I have patients who tell me younger physicians don't generally make eye contact with them and stay at the computer typing furiously. Again, not being familiar with what trainees are being taught these days, it would be helpful to know.
How can physicians regain any leadership or influence if we no longer think eye contact or physical touch an important skill to pass along? I'm not worried (or hopeful?) about AI altering things significantly any time soon. Human connection is supremely important in the practice of medicine and a "chat bot" will not provide what patients want and need. Since AI is not as of yet reliably writing our office notes and placing all orders, I'm not sure why we focus on it changing our roles as physicians that dramatically (certain limited exceptions aside).
With a solid basis of basic medical training and information (that won't change by the time they graduate), medical trainees can join the long line and history of physicians who have kept learning their entire professional careers and stay up on what current guidelines are.
Unfortunately, I never had a mentor of any type in my medical training or practice. What I did have in medical training was camaraderie with intense friendships and "we're all in this together" feeling along with attendings who did model dedication to patient care. Patients were the center of our focus, and the interesting and stimulating discussion and debate over the best way to care for them and learn about the condition they were dealing with.
In daily practice, the tedious data entry and clerical duties that have been foisted on us by the EHR is one of the most frustrating and sole-sucking aspects. And almost complete loss of autonomy or any sense that practicing physicians have much input or direction in big decisions in our communities/national medical stage. These are probably things that need to be addressed from a trainee perspective.
There are some general banalities here that are not objectionable. Yes, finding a role model is always useful. “Mentoring” is required, since medical training is one long apprenticeship. Longitudinal clinics are useful for trainees, because that’s what clinical practice looks like for many/most physicians….so what better way to learn about real life than in a supervised environment using a scaled down version.
But a trainee who has a role on a service requiring a pager accepts a call at 6pm and finds it tolerable only cuz he’s built a relationship with his mentor and it had been a good one?!? What?!? If you’re on service and you’re on a pager, then let’s go son! Get ‘er done! I don’t need to coddle you for a month and get on your good graces before I can expect some work out of you (and some clinical experience and teaching for your benefit). These things are called teaching services for a reason: to get your teaching, you’re gonna need to provide some service. It sounds like the case in question did have useful teachable moments. But even if it didn’t, the point is it is part of the job.
It’s the quid pro quo of medical training, I imagine, since time immemorial. And I don’t see it changing. But as was clear from the part 1 post, and the NEJM article that spawned such discussions….I am not hopeful of the younger generation as a whole stepping up and doing the necessary work. Too much worrying about triggers and micro aggressions. Too little self reflection of “this is what I signed up for”.
I agree entirely with the value of longitudinal clinical mentoring. As a past site director for a 3rd year LIC (longitudinal integrated clerkship) I saw first hand the intrinsic value and personal satisfaction that both students and preceptors got from a trusting educational relationship. Sadly the program was dropped because it didn't scale up..... coorporate medical education clearly values quantity over quality.
Sorry but that horse has left the barn and is long gone. The evolution from private practice to corporatism is fairly complete and the old days and ways are not coming back. As someone that entered practice in the 1970s, I had a ringside seat to watch the process. Some people blame the mindset of corporatism but its successful takeover was made possible by the intervention of government into the marketplace. Once those seeds were planted, the ultimate rot was ensured.
Unfortunately, the shift from mostly private practice to employee physicians and the self focus of the newest generation of docs( less working hours, more pay, time off, etc), has been leading to a medical culture that puts less focus on our relationships with our patients. Docs can switch jobs when they don’t feel “ happy” easily; they don’t need to build a practice by word of mouth , so they don’t really have to invest the same kind of emotional energy and may never develop the relationships with patients that encourage real concern . You react differently to that 3am phone call when you care. After 32 years in one practice, I know. I was a graduate of Hahnemann. Sad.
The author asserts that the medical student's after hours telephone management of a DVT establishes "character" and "moral"fiber. This ignores that teaching someone how to use sq lovenox is often best done in person, and in an integrated system there are pathways for acute care that may include the ER and acute care clinic. The author has an old fashioned view of the heroic individual doctor, on-call to her community 24 hours a day. That is a path to burnout, a luxurious scenario spun out by an academic physician.
As a woman in internal medicine I feel sympathy much more important than empathy. Empathy fatigue can be a source for burnout. The best nurse with whom I worked took Gallup strength finders and empathy was one of her lowest strengths while sympathy one of her highest. Great writing. Keep em coming.
Having practiced in the community for the past 30 years, I have no connection to what is going on in medical education and training. I also get the sense that Dr Rohlfsen does not really understand what medical practice in the "real world" has been like over the past 30 years and where it is currently!
What I do see is twofold - somewhere in medical education, it must be emphasized (and modeled) that the patient is the sacred center of our endeavors. Empathy in trainees should be nurtured (and, again, modeled). This means we don't view patients as "entitled" or focus on the "microagressions". We don't develop a "them vs us" sense. We need to understand and appreciate "human nature". Training programs must foster Oslerian ideals.
The other side of this (and the issue that stresses the ability to feel empathy) is the current status of medicine - and where it has been for the past 30 years. The physician is no longer "leader of the ship". Daily life in medicine is long hours, tedious decisions and tasks all day long, mainly working in isolation (not seeing or interacting with colleagues for most of your day). Being asked to do 45-60 minutes worth of mental work and clerical typing/data entry in a 15-20 minute chunk of time. Being told (by who? CMS?) what constitutes "quality" and how we must "measure" this. It seems that trainees are now taught that "routine physical exam" is no longer a necessary "thing". I have patients who tell me younger physicians don't generally make eye contact with them and stay at the computer typing furiously. Again, not being familiar with what trainees are being taught these days, it would be helpful to know.
How can physicians regain any leadership or influence if we no longer think eye contact or physical touch an important skill to pass along? I'm not worried (or hopeful?) about AI altering things significantly any time soon. Human connection is supremely important in the practice of medicine and a "chat bot" will not provide what patients want and need. Since AI is not as of yet reliably writing our office notes and placing all orders, I'm not sure why we focus on it changing our roles as physicians that dramatically (certain limited exceptions aside).
With a solid basis of basic medical training and information (that won't change by the time they graduate), medical trainees can join the long line and history of physicians who have kept learning their entire professional careers and stay up on what current guidelines are.
Unfortunately, I never had a mentor of any type in my medical training or practice. What I did have in medical training was camaraderie with intense friendships and "we're all in this together" feeling along with attendings who did model dedication to patient care. Patients were the center of our focus, and the interesting and stimulating discussion and debate over the best way to care for them and learn about the condition they were dealing with.
In daily practice, the tedious data entry and clerical duties that have been foisted on us by the EHR is one of the most frustrating and sole-sucking aspects. And almost complete loss of autonomy or any sense that practicing physicians have much input or direction in big decisions in our communities/national medical stage. These are probably things that need to be addressed from a trainee perspective.
There are some general banalities here that are not objectionable. Yes, finding a role model is always useful. “Mentoring” is required, since medical training is one long apprenticeship. Longitudinal clinics are useful for trainees, because that’s what clinical practice looks like for many/most physicians….so what better way to learn about real life than in a supervised environment using a scaled down version.
But a trainee who has a role on a service requiring a pager accepts a call at 6pm and finds it tolerable only cuz he’s built a relationship with his mentor and it had been a good one?!? What?!? If you’re on service and you’re on a pager, then let’s go son! Get ‘er done! I don’t need to coddle you for a month and get on your good graces before I can expect some work out of you (and some clinical experience and teaching for your benefit). These things are called teaching services for a reason: to get your teaching, you’re gonna need to provide some service. It sounds like the case in question did have useful teachable moments. But even if it didn’t, the point is it is part of the job.
It’s the quid pro quo of medical training, I imagine, since time immemorial. And I don’t see it changing. But as was clear from the part 1 post, and the NEJM article that spawned such discussions….I am not hopeful of the younger generation as a whole stepping up and doing the necessary work. Too much worrying about triggers and micro aggressions. Too little self reflection of “this is what I signed up for”.
I agree entirely with the value of longitudinal clinical mentoring. As a past site director for a 3rd year LIC (longitudinal integrated clerkship) I saw first hand the intrinsic value and personal satisfaction that both students and preceptors got from a trusting educational relationship. Sadly the program was dropped because it didn't scale up..... coorporate medical education clearly values quantity over quality.
Sorry but that horse has left the barn and is long gone. The evolution from private practice to corporatism is fairly complete and the old days and ways are not coming back. As someone that entered practice in the 1970s, I had a ringside seat to watch the process. Some people blame the mindset of corporatism but its successful takeover was made possible by the intervention of government into the marketplace. Once those seeds were planted, the ultimate rot was ensured.
Unfortunately, the shift from mostly private practice to employee physicians and the self focus of the newest generation of docs( less working hours, more pay, time off, etc), has been leading to a medical culture that puts less focus on our relationships with our patients. Docs can switch jobs when they don’t feel “ happy” easily; they don’t need to build a practice by word of mouth , so they don’t really have to invest the same kind of emotional energy and may never develop the relationships with patients that encourage real concern . You react differently to that 3am phone call when you care. After 32 years in one practice, I know. I was a graduate of Hahnemann. Sad.
.
Bargaining.
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