from ‘Every Patient Tells a Story’
She’s [Dean of students at Yale Medical School] concerned that medical education spends too much time focusing the students’ attention on the disease and not enough time on the patient. She cringes when she overhears a student refer to a patient by his disease and location, or when the discussion of a cool diagnosis overlooks the potentially tragic consequences for the person with the disease. She worries that the doctors they will become will forget how to talk to the patient, to listen to the patient, to feel for the patient. For years she worried that in the excitement of mastering the language and culture of medicine they might lose the empathy that brought them to medical school in the first place.
2 versions of a patient’s story: first as the patient told it and then as it might have been written up by a doctor… both presented by a doctor who spent a year interviewing African American patients about their experiences in the health care setting…
"In June 1967, I went to Vietnam. I was a member of the First Infantry Division. My first evening there, they sent me out on an ambush." She didn’t have any props, nor a costume, but through her voice and expressions she became this middle-aged black man who never recovered from the battlefields and bars of his year in the Vietnam War. She portrayed this man, clearly destroyed by an almost lethal dose of post-traumatic stress disorder, drugs and liquor. It was a compelling performance.
"I had been drinking. I was very loud and belligerent that night and my sister, who is probably the closest person to me, walked off and said that she was never going anywhere with me again. Afterward, I went out to the Dumpster and i threw the bottle in that Dumpster and I said that I was never going to drink anymore. I tried to stop on my own, but the next morning when the liquor store was open I was right there buying another bottle. A lot of times, people—they want off but they have no control. That is what the bondages of Satan do, using alcohol and drugs.”
The doctor seamlessly switched into a professional voice, with crisp diction and shorn of any accent as she read a re-creation of what a hospital admission note might have read.
"Chief complaint— a 34 year African American male brought in by police; a question of a drug overdose. The history of the presenting illness: The patient was found unresponsive and brought to ER. He was intubated in the field to protect his airway since he was actively seizing, which caused respiratory depression when he was found. In the ER, the patient was minimally responsive to pain. Per police, he had 3 grams of cocaine in pocket. He has been identified by his driver’s license as Mr. R. Johnson whose prior medical records indicate multiple past admissions for drug overdose."
"You’re starting out on the journey across this bridge, this education, and right now you are on the same side as your patients. And as you get halfway over the bridge you’ll find yourself changing and the language the patient had and you had is being replaced by this other language, the language of medicine. Their personal story is being replaced by the medical story. And then you find yourself on the other side of that bridge— you’re part of the medical culture. When you get there, I want you to hold on to every it of your old self, your now self. I want you to remember these patients."