What Med Students Learn From Sticking With Their Patients

Altaf Saadi, a Harvard Medical School student doing an "integrated clerkship" at Cambridge Health Alliance

Medical school is an infamous time of maximal stress, as a student bounces quickly from specialty to specialty and patient to patient, building emotional calluses. In a fascinating interview just out in The Boston Globe about medicine’s tendency to “dehumanize” doctors, Dr. Omar Sultan Haque says, “Empathy decreases as you get more experience with patients. The nicest people you’ll ever find who are doctors are in the first two years of medical school.”

But what if it doesn’t have to be that way? At least, not all of it? A study just out in the journal Academic Medicine reports positive findings on a different model for the third year of medical school: Students follow their patients “longitudinally,” through all their treatments, even from hospital to home.

The study of third-year students in Harvard Medical School’s “integrated clerkship” at Cambridge Health Alliance found that they scored just as well as their peers on standardized tests, but they felt differently about their experience. They saw it “as more humanizing (even transformational) and less marginalizing than do their peers in more traditional clerkships. Strikingly, these strongly positive perceptions exist in the face of an experience that is described as both more hectic and more stressful than the traditional clerkship.”

Here, Altaf Saadi, a third-year Harvard medical student currently participating in the Cambridge Integrated Clerkship, describes what it’s like to have real time to spend with a patient who is going through cancer treatment and navigating the medical system.

By Altaf Saadi
Guest Contributor

This Monday, my internal medicine supervising physician and I saw Helen’s bald head for the first time. “Do you want to see it?” she asked. And, with our encouragement, she slowly removed her caramel-colored wig.

“You two are the first people to see my head like this.”

She was in her third cycle of Cytoxan and Taxol — two chemotherapy medications for treatment of her breast cancer — and she had lost her hair, among a dizzying number of other side effects she has experienced. So we sat there in the primary care clinic, weathering the initial influx of pain, bearing witness to her experience of cancer.

These are real fears patients have, fears that often do not get communicated when relationships are not established with patients.

Helen (not her real name) is one of nearly 500 patients I have seen as part of my third year at the Cambridge Health Alliance. I am one of ten students in this year’s Harvard Medical School-Cambridge Integrated Clerkship, an innovative model for third year medical education that centers learning on the experience of the patient. Traditionally, third year medical students complete discrete “block” rotations in core disciplines such as Internal Medicine, Pediatrics, Obstetrics, and Surgery. They rarely see patients more than once. As part of the Cambridge Integrated Clerkship, we instead spend time in all of the disciplines throughout the year by following “our” patients through those disciplines.

What that has meant for my relationship with Helen, for instance, is that I met her shortly after her initial cancer diagnosis, accompanied her to her surgery, saw her for five weeks of radiation therapy and now through her chemotherapy. At the same time as I interacted with her breast surgeon, radiation oncologist, and medical oncologist, I also worked with her primary care physician to manage her hypertension and a social worker to help her obtain health insurance.

Because of this experience, what I learn in medicine has taken on a whole new meaning. As I go to check in with Helen at her chemotherapy infusion appointments, for example, watching the Cytoxan and Taxol flow from the IV bag, into the tubing, and into Helen’s right arm, the side effects I have memorized are ones I seriously dread. Overpowering, bone-breaking fatigue, blackening of nails, hair loss, acne-like rashes, and taste changes and nausea so bad that it stops her from eating — these are all thing that have actually happened to Helen. I sometimes hear them in her voice when I call and speak to her on the phone. They are also some of the many hurdles on a long, harrowing road of treatment.

I’ve also gotten to see how confusing and scary the American medical system can be for patients to navigate. Helen does not have the best health literacy. She calls me when she has upcoming appointments to make sure I will be there so I can translate the obscure medical jargon some physicians use. I have also gotten used to appointments when she will respond “No” to the physician asking “Do you have any questions?” but then will flood me with questions minutes later when we step outside the doctor’s office.

I have learned most of all from my patients. They bare their hearts to me, and they make me privy to their innermost confidences.

I’m not sure I would have gotten this perspective had I not been invited to share hers through the Cambridge Integrated Clerkship program. I have also learned the importance of providing reassurance to patients, often repeatedly. Her biggest fear going into surgery was that she would be put to sleep forever from the anesthesia. These are real fears patients have, fears that often do not get communicated when relationships are not established with patients.

I have other patients who I have seen multiple times too, some up to 30 times. I am reminded, day in and day out, how fortunate I am to be a doctor-in-training in this innovative model for medical education — a model based in relationships and commitment. In addition to learning from the formative, yearlong relationships I have made with my supervising physicians, I have also learned most of all from my patients. They bare their hearts to me, and they make me privy to their innermost confidences. Daily, I experience and share an inside connection with humankind, joy, courage, life, and death.

The greatest privilege, at the end of the day, is that I can make valuable contributions to their health care as I learn from them. I will never forget noticing the following lines from Helen’s chart last winter: “Patient feels grateful and shared with this writer that when she was awakened from surgery she saw the face of the medical student smiling at her… She will never forget that smile.” I will never forget yours either, Helen.

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  • Andrea

    University of Michigan has a program for 1st and 2nd year medical students that they are expanding into the 3rd year – students follow a family and meet with them individually to discuss their journey through the health system and their experiences with health care. Similar concept, although it would be great to include more of these sessions in the clerkship years, as Harvard is doing. Wonderful story!

  • Kathy M

    I recently spoke with my husbands radiation oncologist who bemoaned the fact that the medical students he works with now are just as bright as when he went to school, but do not have the grueling schedule he had to endure, following patients for long periods of time, which he attributes to his greater understanding of medicine and patient care.  This sounds like a wonderful alternative to what is being currently offered in most medical schools.  Imagine the amazing physicians which will be produced from this program.  Knowledgeable and compassionate.  An unbeatable combination. 

  • JMC

    My spouse completed residency 20 years ago in Boston before we were married.  During that time, the work conversations usually revolved around three major topics: sleeplessness, random terrifying situations in the ICU, and clinic patients.  Because residents kept the same clinic patients for all three years of their training, the respective professional and patient lives became tightly interwoven. Most residents were not the warm and fuzzy types and yet the continuous close patient contact throughout residency created something extraordinary.  A kind of healing bond would spring up between the patient and the resident (the kind of that our super efficient delivery systems of today are more than willing to eradicate).  It is important for expose students and residents to the fruits of a world that goes beyond the 15 minute encounters with people they may never see again.

  • http://twitter.com/drphilxr Philip Kousoubris

    potentially transformative.

  • http://www.viscot.com/ Howie

    I hope this experience makes future doctors more empathetic with their patients. I have high hopes for this.

  • http://www.facebook.com/people/Kathy-Larson-Ahern/581585135 Kathy Larson Ahern

    We are forever grateful to the third year medical student at Cambridge Health Alliance who stood by us through thick and thin during my brother’s terminal cancer.  Not only are these students there for their patients, but for the family who are witnessing the turmoil, pain and suffering their loved ones are going through.  It was such a comfort for all of us to have “Nate” there for every office visit, chemo infusion, emergency room visit, hospital admission and at the end of his life.  I can’t say enough about this wonderful program and hope that other health institutions will eventually implement integrated clerkships for their third year medical students.

  • Stacy

    This sounds like an amazing new effort to better understand a patient’s experience in a more human and personal connection. I hope that other universities are able to adapt the model!

  • http://www.facebook.com/dorothytime Dorothy Finnigan

    It’s inspiring to learn about this new frontier in medical care. :) Hearing Altaf’s experience is meaningful, and I expect if we heard more from “Helen” – or another of these patients – it would be tear jerking. I look forward to seeing this new model develop and spread!