Narrative Medicine Monday: When Patients Mentor Doctors

When Patients Mentor Doctors: The Story Of One Vital Bond” tells of physician Aroonsiri Sangarlangkarn’s longitudinal relationship with a patient she comes to call a friend. The bond between them affects her views on what can be gained through understanding patients on a more personal level.

Sangarlangkarn first meets Roger as part of a medical school program that matches up aspiring physicians with geriatric patients who provide mentorship on medicine from a patient perspective. She then encounters him again after she has finished her training and he is hospitalized under her care. She reflects on the value of her deep knowledge of his personality and history.

I liked reading about Sangarlangkarn’s own lengthy description, written years prior as a medical student, of the patient’s social history. It included intimate details such as Roger’s parents’ names, his boyhood aspirations and his favorite board game. When I was a medical student I remember taking a very detailed history of a woman who was in the hospital for treatment of her malignant tumors. I spent over an hour with her, just chatting with her about her history. No physical exam, no review of medications. The final typed up document I turned into my advisor was over two pages long. Now, as a busy primary care physician, I, like Sangarlangkarn, can see how the emphasis on efficiency causes time constraint that makes it difficult to have meaningful patient-physician conversation that could contribute to helpful personal knowledge. Sangarlangkarn laments that “our interactions with patients have become so regimented and one-dimensional that we no longer get to know the multifaceted person outside the hospital.”

What do you think about Sangarlangkarn’s suggestion regarding the value of patient home visits? This is often done for patients in hospice care or who are unable to physically get to a clinic. Home visits because of the time they require seem much more costly to the system but Sangarlangkarn argues that the value – the ability to get to know the patient on a different level – provides invaluable information. She writes: “To effectively provide care for someone, it’s important to learn who they are, what they eat, how they breathe.” She, in fact, due to her detailed knowledge of the patient, is the only one who eventually can get him the end of life care and support he needs.

Writing Prompt: Think about a time you visited an ill person at home, whether that be an apartment, house or adult family home. Describe what you saw, what you smelled, what you talked about, how you felt. What do you think can be gained by entering into a person’s living space? Alternatively, consider a patient you’ve known for years, maybe decades. What do you know about that patient because of a longitudinal relationship that might be of benefit to you if you had to deliver bad news or discuss different treatment options or medications? Write for 10 minutes.

 

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Narrative Medicine Monday: Things My Daughter Lost In Hospitals

Toni L. Wilkes reveals her daughter’s illness journey through her poem “Things My Daugther Lost In Hospitals” in the journal The Healing Muse. I’m struck by how she alternates between the physical, tangible losses (“a pear-shaped gallbladder”) and the more unexpected costs (“her husband’s patience”). As a reader, I almost miss the surprising and heart wrenching losses, placed innocuously among the more conventional ones. I’m compelled to return to each line and deconstruct the poem, in search of these melancholy nuggets that reveal the true toll.

Writing Prompt: List all of the things you’ve lost or gained by being a medical provider. Alternatively, list all of the things you’ve lost or gained through an illness. Consider the concrete (i.e. money) and the more intangible (i.e. time). Write for 10 minutes. 

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Narrative Medicine Monday: Close Encounter

Abraham Verghese writes about his experience treating victims of hurricane Katrina in his essay “Close Encounter“. The experience reminds him of working overseas in India and Ethiopia, where “the careful listening, the thorough exam, the laying of hands was the therapy.” Have you ever been in a situation providing medical care when this type of personal touch was the primary treatment? What does taking away many of the medical resources that we take for granted reveal about the other important aspects of medicine? 
Verghese goes on to describe a dignified man in his 70’s who has a chilling tale of survival. Verghese reflects on what it means to say and to hear “I’m so sorry.” What do you think it means to this man to hear those words? 

Writing Prompt: Verghese begins and ends his piece mentioning the “armor” providers strap on for challenging work shifts. Have you tried to wear such armor in your practice? What was the result? As a patient have you been cared for by medical professionals who seem to wear this armor? How did they come across? Have you ever been “wounded” by a patient interaction? Do you agree with Verghese  that the willingness to be wounded may be all we have to offer as providers? 

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Narrative Medicine Monday: An Enlarged Heart

Cynthia Zarin writes a detailed account of a time her daughter fell ill in “An Enlarged Heart”. She explores her own realization that her daughter was significantly sick and also documents her encounters with the medical system on the path to diagnosis and treatment. 

Writing prompt: Write about a time when you were caring for a loved one with an unexpected illness. How did you respond? What were the challenges you encountered with the health care system? What, if anything, did you struggle with yourself?

 

 

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Narrative Medicine Monday: My Patient Doesn’t ‘Do’ Vaccines

The New York Times Well column features many excellent pieces about medicine from the patient, physician and public health perspectives. Danielle Ofri’s “My Patient Doesn’t ‘Do’ Vaccines” is a snapshot of an every day encounter for a physician: a patient disagrees with the recommended care plan. Although immunizations are one of the most common areas of disconnect these days, this can and does happen in many other situations as well: a patient requests antibiotics for a viral illness, a physician recommends a procedure that a patient doesn’t want, a patient requests labs or studies that aren’t indicated, a physician recommends a medication that a patient is hesitant to take. Instead of just letting the situation pass by during a busy clinic day, Dr. Ofri decides to become curious, to engage her patient and educate him on the medical science. He, in turn, is able to voice his concerns and viewpoint.

Writing Prompt: Write about a time there was a disconnect between you and your physician or your patient. Were you curious during the encounter to understand the other person’s fears, concerns or hesitation? Why or why not? As providers, how best can we address valid concerns while staying true to evidence based care? How do our backgrounds color our perspective and ability to engage others?

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