osteomyelitis, a bone infection that is a frequent complication of diabetic foot ulcers.
Medical students on a care team are often asked to "take a history" from patients—interview them about the details of their current and past health status. This both helps students appreciate the progression and interconnectedness of health-care problems and brings another set of eyes and ears to bear on patients' care.
So even though Mr. Miller's history had been taken many times before, my attending had asked me to take it again. I walked into his room, introduced myself to Mr. Miller and his daughter, and began asking them questions. As the conversation progressed, I noticed that Mr. Miller seemed to expect me to remember certain past events in his life and that, while addressing me, he referred to his wife as "your mother." After the interview ended, I walked out of the room with his daughter, who immediately pointed out that her father thought I was one of his daughters. But rather than seeing this as cause for concern about her father's mental status, she considered it a sign of how comfortable he had felt with me—as the reason he had been so willing to open up during our conversation.
After I went home that night, I couldn't stop thinking about Mr. Miller. As I mulled over what had transpired, I began to understand the import of what had happened that day. He had reminded me of the privileged role that physicians play in their patients' lives. To him, my role was virtually indistinguishable from that of a family member. While a myriad of medical conditions could have accounted for his mental lapse, it was nevertheless a potent reminder of my responsibility as a health-care provider: I needed to care for him as if he were my father—indeed, for all of my patients as if they were members of my family.
As I continued to help care for Mr. Miller, I found he had still more to teach me about the humanistic side of medicine. One day we were having a rare slow
I noticed that Mr. Miller seemed to expect me to remember certain past events in his life and that, while addressing me, he referred to his wife as "your mother." After the interview ended, I walked out of the room with his daughter, who pointed out that her father thought I was one of his daughters. But rather than seeing this as cause for concern about her father's mental status, she considered it a sign of how comfortable he had felt with me. —Heather Sateia '08
afternoon on the medicine floor, so my attending, Dr. Edward Merrens, decided to hold a teaching session. Rather than sit in a conference room and discuss in the abstract the intricacies of diabetes management or the new cholesterol guidelines, Dr. Merrens took us to Mr. Miller's bedside. He asked Mr. Miller and his wife if they'd feel comfortable with our discussing some of his physical findings. Mr. Miller immediately sat up straighter, smoothed his hair, fixed his bedsheets, and eagerly replied that he would be happy to help.
The team's other medical student and I took turns identifying abnormal physical exam findings as we looked over Mr. Miller. Dr. Merrens asked us what each finding meant and how it tied in to our patient's overall clinical status. Mrs. Miller would sometimes chime in with a question, and we would translate our findings so that she could understand them. We
I feel lucky to have seen such a stunning
example of how humanistic medicine can be practiced. I hope I spend my career working to remember these lessons and to incorporate them into my own practice. discussed, for example, why Mr. Miller's left arm had so many broken blood vessels (they were due to sun damage while driving), why his shins were brown (this was because of hemosiderin deposition, or the accumulation of excess iron in his cells), and why he had no hair on his legs (this was from vasculopathy, or damage to the blood vessels—in this case due to diabetes).
Both Mr. Miller and his wife were rapt during our discussion; they had never thought to ask many of these questions but now could identify and understand the various physical manifestations of the diseases that affected him. But what was most remarkable was not the fact that this exchange was taking place among the patient, his family, and the medical team. We could have been discussing a hangnail on his left little finger and it would have had the same effect. Mr. and Mrs. Miller clearly appreciated being part of the process and interacting with the health-care team. It was an incredible educational experience for me—certainly from a physiological perspective (I did learn a lot about diabetes management that day) but also from a humanistic perspective. Dr. Merrens was able to seamlessly incorporate teaching the two of us students with building a relationship with the patient and his family. It was a technique and an experience that I will not soon forget.
The two weeks I spent caring for Mr. Miller were, in essence, a syllabus in the practice of humanistic medicine. Mr. Miller reminded me from the moment I met him of the incredible role that physicians play in patients' lives and of the responsibility that comes with that role. He also was pivotal in demonstrating how caregivers' interactions with their peers and coworkers are another component in the practice of humanistic medicine and of how seamlessly those relationships can dovetail with direct patient care.
These five narratives were written by Dartmouth medical students upon their induction into the Gold Humanism Honor Society. A national organization with chapters at 72 of the nation's 129 medical schools, the Gold Society recognizes students for their compassion and dedication to service. For last year's Dartmouth induction ceremony, the society's newest members were asked to describe an especially meaningful encounter during their medical education. Five of the narratives prepared for that occasion have been adapted for publication here. The names of all the patients mentioned, as well as key identifying details about their cases, have been changed in order to preserve their confidentiality.
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