Teaching Doctors To Care

Claire Brickell, 25, an aspiring neurologist in her third year at Harvard Medical School, already knows far more about health care than most of us. She can diagnose heart failure from a chest X ray. She can diagram the intricate circuits of the brain. And if she needed to, she could probably pull off a pretty decent tracheotomy. But when it comes to communicating with patients, Brickell has a problem: she's too healthy. Like most of her classmates, she has spent very little time as a patient. She has never had to weigh the advice of a trusted friend against conflicting orders given by a cold and distant doctor. She has never had to take daily injections for a disease she doesn't understand. She has rarely even gone through the most basic crucible of illness in the U.S., the interminable wait in a doctor's office.

Enter Santa Ocasio, 56, a Dominican immigrant who is fighting a protracted battle with Type 2 diabetes. In a pilot program that is the leading edge of a broad curriculum overhaul at Harvard Medical School, Brickell has been paired with Ocasio for nearly five months. She sees her as a patient every week at the Spanish Clinic of Boston's Brigham and Women's Hospital and tags along on visits to her specialists. In fact, the goal is for Brickell to be there every time Ocasio encounters the health-care system. It's not just a way to learn about treating diabetes; it's a crash course in the myriad frustrations of a patient caught in the maw of modern medicine--confusing prescriptions, language barriers and an endless parade of strangers in white coats.

Why would the U.S.'s top medical school ask its students to spend valuable time trailing a patient instead of a doctor? At Harvard and other medical schools across the country, educators are beginning to realize that empathy is as valuable to a doctor as any clinical skill. Whether it's acknowledging that a patient was inconvenienced by having to wait an hour before being seen or listening when someone explains why he didn't take his meds, doctors who try to understand their patients may be the best antidote for the widespread dissatisfaction with today's health-care system.

So Harvard has built closer partnerships between students and patients into the principal clinical experience, a small but important part of its most significant curriculum reform in two decades. The University of Pennsylvania Medical School began a similar program in 1997, and other schools are following suit. As long as medical students are still getting a healthy diet of clinical learning, educators say, there's little downside.

Still, centering clinical learning on patients is a fairly radical concept for a medical-education system that is notoriously resistant to change. Medical schools operate largely on principles established in 1910. For most of the intervening century, the third year of medical school has meant total immersion in a series of clerkships in the major fields--six weeks in cardiology, six weeks in intensive care and so on. Students met patients when they were admitted into that section of the hospital, and the relationships ended as soon as the patients were discharged or moved to another ward.