Tell me how your school prepares you to...

[kouhiiko]

I am interested in how different allopathic medschools prepare students to discuss difficult news (such as a diagnosis of cancer or alzheimers) with patients and families.

How about where the patients/families are communicating through interpreters or across very different cultural/economic backgrounds/spiritual beliefs, etc?

Do your instructors and MDs that you work with (as preceptors, etc), ever talk about the difficulties of balancing the responsibilites to the patient (taking the time to address their individual needs and concerns) while remaining mindful of the limited resources of time and money to spend on each patient/visit.

I recently finished "The Spirit Catches You and You Fall Down" and "Mountains Beyond Mountains." I also had an experience recently where I observed caregivers rushing a patient through important education about the patient's post-hospital-stay care...the patient was also given written materials (in English). I felt very uncomfortable later when it was explained to me that the interpreter is very expensive (paid by the hour) and so they tried to speed things along for the sake of cost effectiveness...is this the kind of thing that I have to look forward to when I graduate??

These are rather broad and seemingly unrelating questions. I am really excited about becoming a physician, but I wonder how I am going to feel when I reach the other side...am I going to be able to practice responsible, respectful, and compassionate medicine in the system that we have now? I guess what I am curious about it how different schools approach teaching the non-science part of medicine (that is, the service and business sides medicine) and how it works (and often doesn't work) in the US. (BTW, by business, I mean the financial realities of staying afloat in this system...I really couldn't give a hoot about the money part for myself, as long as I can pay my student loans afterwards...yes, seriously...)

Thanks for your thoughts.

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[excalibur]

These are the thoughts of someone who obviously hasn't gone through the gauntlet....

When you get your cherry popped in clinical rotations, you'll see that speed is paramount, and unfortunately you don't have time to make sure the patient is having that goo-goo ga-ga pleasant hospital experience.

 

[Law2Doc]

These are the thoughts of someone who obviously hasn't gone through the gauntlet....

When you get your cherry popped in clinical rotations, you'll see that speed is paramount, and unfortunately you don't have time to make sure the patient is having that goo-goo ga-ga pleasant hospital experience.

Med schools give a lot of play to the idea of "empathy". But you won't usually have a class or session as to how to break bad news. I think that sometimes falls into the "see one, do one" category at a lot of schools.

 

[dutchman]

I am interested in how different allopathic medschools prepare students to discuss difficult news (such as a diagnosis of cancer or alzheimers) with patients and families.

How about where the patients/families are communicating through interpreters or across very different cultural/economic backgrounds/spiritual beliefs, etc?

Do your instructors and MDs that you work with (as preceptors, etc), ever talk about the difficulties of balancing the responsibilites to the patient (taking the time to address their individual needs and concerns) while remaining mindful of the limited resources of time and money to spend on each patient/visit.

I recently finished "The Spirit Catches You and You Fall Down" and "Mountains Beyond Mountains." I also had an experience recently where I observed caregivers rushing a patient through important education about the patient's post-hospital-stay care...the patient was also given written materials (in English). I felt very uncomfortable later when it was explained to me that the interpreter is very expensive (paid by the hour) and so they tried to speed things along for the sake of cost effectiveness...is this the kind of thing that I have to look forward to when I graduate??

These are rather broad and seemingly unrelating questions. I am really excited about becoming a physician, but I wonder how I am going to feel when I reach the other side...am I going to be able to practice responsible, respectful, and compassionate medicine in the system that we have now? I guess what I am curious about it how different schools approach teaching the non-science part of medicine (that is, the service and business sides medicine) and how it works (and often doesn't work) in the US. (BTW, by business, I mean the financial realities of staying afloat in this system...I really couldn't give a hoot about the money part for myself, as long as I can pay my student loans afterwards...yes, seriously...)
Thanks for your thoughts.

Lord have mercy. Then why are you worried about finance? I am yet to see a professional school that teaches you how to stay afloat financially(with the exception of business schools). If your only financial goal is to pay back your tuition then you will be fine, although I believe this kind of attitude helps drive doctors wages down.

 

[kouhiiko]

I understand that some skills are learned "on the job" and that a person will often improve their ability to communicate effectively and empathetically with time and practice. But, that said, it is easy to fall into a pattern/habit and not realize that what one is doing is not effective or sensitive, or perhaps downright disrespectful or dangerous. But, without formal training, students are left with the possibility of being paired with mentors who may have little training of that type, or may not even care (of course this varies from person to person and among the different specialties....). What I am saying is, it is desirable to be trained/guided by people who really understand the different issues that affect our ability to communicate/treat various patients responsibly and compassionately (as well as quickly...when necessary)

I read an article in the NY times a while back that discussed the frequent complaint by patients that physicians who regularly have to break difficult news to patients and their families are lacking in the communication department, even if the physician is very experienced. (the article specifically mentioned oncologists) The article noted that a group of physicians and patients, who had recently participated in a special training program to improve communication skills, agreed that improved communcation between physicians and patients should be included in the medical school curriculum (and, in fact, that these training courses can be very effective for many physicians). I wonder about the extent that this training actually occurs, or is being considered as many schools revamp their respective curricula.

 

[kouhiiko]

Lord have mercy. Then why are you worried about finance? I am yet to see a professional school that teaches you how to stay afloat financially(with the exception of business schools). If your only financial goal is to pay back your tuition then you will be fine, although I believe this kind of attitude helps drive doctors wages down.

I am worried about the finances because practicing medicine that is financially irresponsible may not be in the interest of the patient, could get me fired (if I work for someone else, and I am too slow because I am taking more time than the minimum to talk to my patient), and if I were to go into private practice, could sink the practice.

How do you think this attitude drives wages down? I am not suggesting that I am going to work for free, but I am not working with an eye toward extravagant living. I am aiming for a reasonable middle ground.

 

[dutchman]

I am worried about the finances because practicing medicine that is financially irresponsible may not be in the interest of the patient, could get me fired (if I work for someone else, and I am too slow because I am taking more time than the minimum to talk to my patient), and if I were to go into private practice, could sink the practice.

How do you think this attitude drives wages down? I am not suggesting that I am going to work for free, but I am not working with an eye toward extravagant living. I am aiming for a reasonable middle ground.

cool. sorry I misunderstood you

 

[DoctorFunk]

Med schools give a lot of play to the idea of "empathy". But you won't usually have a class or session as to how to break bad news. I think that sometimes falls into the "see one, do one" category at a lot of schools.

Actually my school had an hour and a half lecture in the Medical Ethics class on delivering bad news to patients, complete with a humorous video featuring ways not to deliver bad diagnoses followed by proper etiquette. Then a week later we were given a scenario featuring a young man killed in a car accident and told to tell his parents that their son died as part of a "Bad News OSCE."

Of course the parents were played by our course small group facilitators, and of course I had to repress the urge to laugh the entire time. I guess my dreams of becoming a Broadway actor might have to be shelved.

 

[Dookter]

We have a course that runs two years on patient interactions. We do all sorts of stuff, from videotaping fake interviews, talking with patients on the wards, interviewing standardized patients in front of other students/teachers. Later in the year we will learn the "bad news" part. We basically cover all aspects of the doctor/patient interaction.

 

[jbrice1639]

we have a program where we work with the hospital chaplains dealing with patients and families going through difficult times, receiving bad news, and dealing with dying. i haven't done it yet (we do it in small groups throughout first year, and my group isn't til january), but i have heard great things from the people who have already done it. i tried to find a link to the program to post here, but everything on our web site regarding this program was in pdf form...

 

[glp]

My school suggests using a barbershop troupe.

http://www.youtube.com/watch?v=xIsOMT5ETPI

 

[ZacharyMD]

My school suggests using a barbershop troupe.

http://www.youtube.com/watch?v=xIsOMT5ETPI

Hilarious