Teaching Doctors To Care

Sunday, May. 21, 2006 By NATHAN THORNBURGH/BOSTON
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Dr. Erik Alexander, who directs the new program at Brigham and Women's, says the old model prevents students from seeing the larger picture. Every patient is a complex combination of sickness and health across multiple biological systems, and patients are regularly shuttled between various parts of the hospital in the course of their treatment. The best doctors in the future, he says, will make those connections across fields and treat the patient as a whole individual, not a series of symptoms.

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Cambridge Hospital, a Harvard-affiliated branch of Cambridge Health Alliance, took the patient-partnering concept even further, including group lunches and, in some cases, home visits. Dr. Barbara Ogur, who co-directs the Cambridge pilot program, says that for too long, medical students in their third year suffered what she calls "ethical erosion," in which the pace and pressure of the hospital floor desensitized students to the physical suffering and minor indignities of being a patient.

For third-year student Rachel Bortnick, 27, a science buff from childhood, one of the lasting lessons is that patients sometimes don't want the help she is being trained to give. One cancer patient, whom she had followed from initial diagnosis through treatment, decided to quit chemotherapy so that he could leave the hospital, essentially to die.

"It's hard to watch a patient at death's door," says Bortnick. "You want to do something to prevent it. But this patient really wanted peace and quiet, to be somewhere he wouldn't be intruded in on by doctors every hour of the night." Bortnick eventually made peace with her patient's resignation, and after he died earlier this year, she attended his funeral.

It's clear that experiences like that are meaningful to the students, but health-care advocates say patient-centered rhetoric has been around for at least as long as HMOs. The fact is, even the most exquisitely ethical medical students will have to work in a health-care system that is driven by the pressure of the bottom line. Marcia Hams, program coordinator with the health-care advocacy group Community Catalyst, says Harvard has the right idea. For students from other Boston-area medical schools, her organization tries to impart a similar lesson with Walk in My Shoes, a program that asks students to simulate patient tasks like signing up for Medicaid or searching for an interpreter in a hospital. But Hams cautions that it will take more than curriculum reform to get patients the care they deserve. "If doctors only get a minute and a half with a patient," she says, "then whatever they learned in med school about patient needs isn't going to matter a lot."