Great article with many good suggestions to improve medical training. I look back at my two residencies and recognize that much of the work we did was based on generating income for our departments, and less on true “training”. Still, I had some VERY good attendings who would take us under their tutelage, and truly “teach us”. I miss those teachers! Still keep up with a few of them.
Shadowing should be done before residency. I shadowed during summers in college, and during free time in medical school. Residency is hectic enough as it is without residents just "shadowing" and not learning skills. They can learn by presenting cases to their attendings.
Great article. I have retired 10 years ago from active practice. In pediatrics when I was at a medical center, in the 80's and beyond, students had for their clinicals, 4 weeks in-patient peds and 4- 1 week each rotations in private pediatric offices, including at least 1 or 2 in specialty offices. It seems like a great thing. I am certain this has expanded. Thank you for your insights.
This is very feet on the ground. I'm currently studying undergrad but I'm already trying to find mentors. I want to get into psychiatry. I have a copy of Michael Alan Taylor's textbook by my bed. It's full of all sorts of practical advice about how to listen and observe. I hope I will be able to shadow a wise person one day.
While I agree with the sentiment, I disagree with the source of the problem. It's not that physicians *don't* want to be compassionate and empathetic, it's that they have been robbed of the opportunities to be so. They are not burnt out, they are exploited, forced into seeing more and more patients in less and less time until they, their staff, and the patients all become cogs in a great big "healthcare" machine, not the irreplaceable unique humans that they, each and every one, actually are.
Fix that problem, but don't blame today's doctors for it. This particular ball started rolling before most of today's doctors were even born--and our predecessors helped it start.
My 42 year ER career was mostly Locums. 15 different states and cities within them. My colleagues were invaluable as knowledge sources. From diagnostics to procedures my varied lessons served myself and my patients well. Often I surprised my peers with uncommon and successful techniques.
We don't stand alone. We work together for a common good.
Robert, I dould not agree with you more! Excellent article. As a Professor of Psychiatry at Hopkins, one of the most valuable lessons my medical students and residents that I taught over 2 decades said was the way I approached patients. They are people like us, with unique strengths, interests and abilities. To treat them mechanically the same way with just a check list on EPR dehumanizes them. Thanks for echoing my thoughts. Regards.
I have attended many funerals and viewings of my patients over the years. However, in the last 20 years, the maintenance of a long term relationship with the patient and the families have not been sustained. I received many thank you after patient deaths over the last 45 years in practice but very few in the last 10 years. The term “continuity of care” has disappeared from the medical vocabulary. It is all about “the team”.
really enjoyed this piece - when I dug deep into the history of modern medicine earlier this year for a piece on our substack I was struck with how profoundly the Flexner report shaped our current system. Much like when the Rockefeller Foundation joined forces with the government of Mexico to launch the Mexican Agricultural Program (MAP) which led to the Green Revolution and ultimately to the food system we have today that is centered on cheap calories. I appreciated reading your personal experiences and a window into what medicine was and could return to. Thank you for caring for your patients they way you do.
As a medical student, I certainly agree that your primary objective is to learn the basics of the science of medicine. As you go through your training, if you are going to be dealing directly with patients, then the art of medicine will take on a more important role. It's the art of medicine where observing others has benefits because we do not have a mirror on ourselves when we are doing our work. I am sorry that you have not had a lot of positive role models so far but sometimes even negative role modeling can teach us something. Good luck in your career
This was a wonderful read, and I am sharing it with my daughter who is applying to med school. I would love for the next generation of physicians to benefit from such observational compassion.
I own an outpatient PT practice now for 15+ years. I had a former patient's grand daughter call to "shadow". She is studying philosophy and sociology, basically nothing related to PT entrance requirements! She thinks that after doing an internship in mediation, she thinks she chose the wrong major. What was interesting is that she followed all three of the clinicians in the clinic, myself being one of them. I felt my goal was for her to see the human side of the art of PT. This is what sustains me. I did not go into techniques or treatment ideas or do this exercise for this muscle. I wanted her to see how amazing my day is because it is filled with human relating and connecting. Anyone can prescribe an exercise, not everyone can hold space to hear how pain is tiring or frustrating or family and work are even worse than pain. That's what I love about my job and am grateful I found my calling.
What you said captures the real soul of the profession. Healing isn’t just physical, it’s the quiet art of helping people feel seen when they’re at their lowest. The way you describe your work reminds me that empathy is still the most advanced therapy we have.
That’s such a good observation. The best teachers never stop being students themselves. It’s that balance between curiosity and wisdom that keeps learning alive and meaningful.
Your patients don't really care what you know, but they really need to know that you care.
Great article with many good suggestions to improve medical training. I look back at my two residencies and recognize that much of the work we did was based on generating income for our departments, and less on true “training”. Still, I had some VERY good attendings who would take us under their tutelage, and truly “teach us”. I miss those teachers! Still keep up with a few of them.
Shadowing should be done before residency. I shadowed during summers in college, and during free time in medical school. Residency is hectic enough as it is without residents just "shadowing" and not learning skills. They can learn by presenting cases to their attendings.
Great article. I have retired 10 years ago from active practice. In pediatrics when I was at a medical center, in the 80's and beyond, students had for their clinicals, 4 weeks in-patient peds and 4- 1 week each rotations in private pediatric offices, including at least 1 or 2 in specialty offices. It seems like a great thing. I am certain this has expanded. Thank you for your insights.
This is very feet on the ground. I'm currently studying undergrad but I'm already trying to find mentors. I want to get into psychiatry. I have a copy of Michael Alan Taylor's textbook by my bed. It's full of all sorts of practical advice about how to listen and observe. I hope I will be able to shadow a wise person one day.
While I agree with the sentiment, I disagree with the source of the problem. It's not that physicians *don't* want to be compassionate and empathetic, it's that they have been robbed of the opportunities to be so. They are not burnt out, they are exploited, forced into seeing more and more patients in less and less time until they, their staff, and the patients all become cogs in a great big "healthcare" machine, not the irreplaceable unique humans that they, each and every one, actually are.
Fix that problem, but don't blame today's doctors for it. This particular ball started rolling before most of today's doctors were even born--and our predecessors helped it start.
My 42 year ER career was mostly Locums. 15 different states and cities within them. My colleagues were invaluable as knowledge sources. From diagnostics to procedures my varied lessons served myself and my patients well. Often I surprised my peers with uncommon and successful techniques.
We don't stand alone. We work together for a common good.
Robert, I dould not agree with you more! Excellent article. As a Professor of Psychiatry at Hopkins, one of the most valuable lessons my medical students and residents that I taught over 2 decades said was the way I approached patients. They are people like us, with unique strengths, interests and abilities. To treat them mechanically the same way with just a check list on EPR dehumanizes them. Thanks for echoing my thoughts. Regards.
I have attended many funerals and viewings of my patients over the years. However, in the last 20 years, the maintenance of a long term relationship with the patient and the families have not been sustained. I received many thank you after patient deaths over the last 45 years in practice but very few in the last 10 years. The term “continuity of care” has disappeared from the medical vocabulary. It is all about “the team”.
Nice post. I agree, it's important to have good role models, and if we can do rhe same for the next generation. You have
really enjoyed this piece - when I dug deep into the history of modern medicine earlier this year for a piece on our substack I was struck with how profoundly the Flexner report shaped our current system. Much like when the Rockefeller Foundation joined forces with the government of Mexico to launch the Mexican Agricultural Program (MAP) which led to the Green Revolution and ultimately to the food system we have today that is centered on cheap calories. I appreciated reading your personal experiences and a window into what medicine was and could return to. Thank you for caring for your patients they way you do.
Heather,
As a medical student, I certainly agree that your primary objective is to learn the basics of the science of medicine. As you go through your training, if you are going to be dealing directly with patients, then the art of medicine will take on a more important role. It's the art of medicine where observing others has benefits because we do not have a mirror on ourselves when we are doing our work. I am sorry that you have not had a lot of positive role models so far but sometimes even negative role modeling can teach us something. Good luck in your career
Bob Eidus
This was a wonderful read, and I am sharing it with my daughter who is applying to med school. I would love for the next generation of physicians to benefit from such observational compassion.
We all have heroes that have taught us much, both intentionally and unintentionally. Where have the giants all gone?😢
Experience is not what happens to you; it's what you do with what happens to you," Aldous Huxley
I own an outpatient PT practice now for 15+ years. I had a former patient's grand daughter call to "shadow". She is studying philosophy and sociology, basically nothing related to PT entrance requirements! She thinks that after doing an internship in mediation, she thinks she chose the wrong major. What was interesting is that she followed all three of the clinicians in the clinic, myself being one of them. I felt my goal was for her to see the human side of the art of PT. This is what sustains me. I did not go into techniques or treatment ideas or do this exercise for this muscle. I wanted her to see how amazing my day is because it is filled with human relating and connecting. Anyone can prescribe an exercise, not everyone can hold space to hear how pain is tiring or frustrating or family and work are even worse than pain. That's what I love about my job and am grateful I found my calling.
What you said captures the real soul of the profession. Healing isn’t just physical, it’s the quiet art of helping people feel seen when they’re at their lowest. The way you describe your work reminds me that empathy is still the most advanced therapy we have.
Wonderful article Bob.
You are still teaching and still learning.
Both are important and both impressive.
Thanks for sharing
That’s such a good observation. The best teachers never stop being students themselves. It’s that balance between curiosity and wisdom that keeps learning alive and meaningful.
Thanks Andy
I hope you are well