Does my definition of clinical experience need to be revamped?

[LizzyM]

Just read this essay in The New England Journal of Medicine and wondered if clinical experience still needs to be "close enough to smell patients?" I do think so but this made me realize how removed from the "bedside" some internists are even while actively providing patient care. :sad:

https://www.nejm.org/doi/full/10.1056/NEJMp2303664

apologies if this is behind a paywall.

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[deleted1163194]

Good article. I'm just an applicant so I know nothing, but I do know that the moments I've spent with patients really hammer in how emotional and human medicine is. When I'm with a doctor just charting or doing something else at the hospital it is easy to remove the human element and appreciate the raw scientific coolness that you get to see. But being with patients and hearing their stories is a reminder of what the field is really about (to me, at least).

 

[LizzyM]

Good article. I'm just an applicant so I know nothing, but I do know that the moments I've spent with patients really hammer in how emotional and human medicine is. When I'm with a doctor just charting or doing something else at the hospital it is easy to remove the human element and appreciate the raw scientific coolness that you get to see. But being with patients and hearing their stories is a reminder of what the field is really about (to me, at least).

That's what worries me about this new way of doing things. Will physicians burn out more quickly without relationships, voices, and faces? Is answering text messages all day (and all night) what anyone signed up for?

 

[deleted1163194]

That's what worries me about this new way of doing things. Will physicians burn out more quickly without relationships, voices, and faces? Is answering text messages all day (and all night) what anyone signed up for?

Maybe. I don't think it fares well for patients either.

 

[RocuroniumRedux]

Great read, articulates several of the thoughts I had while working at an EHR company. I think defining clinical experience as being "close enough to smell patients" is still a useful heuristic, even with the delivery of healthcare being blended so closely with technology and abstraction over abstraction. I've had some friendly debates with adcoms at the AAMC career fair on whether or not my EHR floor support experience is clinical, and it seems to be a clean 50/50 split on the classification. I'd argue that getting yelled at by a patient as I try to fix a broken discharge workflow is clinical since it directly impacts the patient experience, but the waters are much more muddy if I'm working on code for a TAVR chart correction or a software crash. There were times when it felt like there was a dangerous rift between my actions and the people behind the MRNs, and I can only imagine how much worse it is when you're the physician responsible for the patient's care.

 

[deleted1163682]

Telehealth is the new future for many underserved patient populations. I know many people at my UG who work with our affiliated medical school call geriatric patients in the morning to remind them to take their medication, ask how they are feeling, plans for the day, etc. The patients find it useful rather than burdensome in most cases and are able to interact with someone who cares about their health. While they don't "smell" patients, I think this is a great activity and is clinical in nature. And before someone calls this scutwork, the patients are happy, the volunteer is happy, everyone is happy.

 

[Mr.Smile12]

Darn firewall. I haven't gotten it yet.

I think you cannot avoid the importance of relationship building at the core of any doctor-patient relationship. Dr. Verghese (sp) makes the point that the EMR often separates the patient from the physician.... distilling the patient as a record instead of a person. To some extent, this has contributed to the burnout issues we are experiencing.

The challenge is that when care becomes too transactional, too textbook, the murky unknown chronic issues become very difficult. The basics about understanding reliability of studies, science mechanisms, and social barriers works for academically trained physicians, but humanism and coordinated teamwork still play a role to help patients heal or find peace. Patients are not neat and tidy, and health care providers must have the strength to stay focused even when the patient is at their worst.

I also note coming from the dental side of things, you still aren't going to be doing your own root canals. There remain limits to relying on tech and wifi.

 

[Nontrad_FL_LGBT]

Honestly, I did some telehealth shadowing with a psychiatrist and found it extremely eye opening. Being able to see the environment patients are living in gives a lot of context. I feel like telehealth is definitely clinical experience.

 

[Fluidity of Movement]

I've been wanting for you to come around to this for a while ^=^

Especially in mental health settings, many things are (by necessity) virtual or online, and definitions are "de-clinicized" for stigma reasons.

My classic example are suicide hotlines or crisis counselors, or separately mental health 'coaches.'

Psychiatry and Psychology both rely on the medical model, and many 'educational' things are considered "medically necessary" by insurance.

And I will die on the hill that someone who is in an emergency with a potentially life threatening condition calls 988 and gets a responder who helps them get to a hospital, is similar to someone in an emergency with a potentially life threatening condition calling 911 and gets a responder who helps them get to a hospital.