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Medical Students Learn to Retain Their Compassion
Recently, San Antonio physician Jerald Winakur saw a patient who reported terrible pain in his left shoulder. The man had been treated at a hospital emergency room over the weekend, where a chest x-ray had been clear.
Listening to his patient's chest, though, Dr. Winakur suspected the man had pneumonia. He ordered a second chest x-ray, which confirmed his diagnosis.
“If someone had just listened to his chest, they could have heard that, too,” Dr. Winakur said. “Because no one had – it was three days later before treatment was started.”
Physically examining patients.
Listening to them.
Taking good histories of their lives.
These are all part of the art of medicine Dr. Winakur and his colleagues at the Center for Medical Humanities & Ethics at The University of Texas Health Science Center at San Antonio want their medical students to learn. Without this kind of physical and emotional contact and communication between doctor and patient, both parties are dissatisfied and trust is eroded.
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Dr. Jerald Winakur urges medical students to treat their patients with compassion and to consider the human, social and ethical aspects of their decisions. |
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"In many ways, we've moved away from the bedside,” said Abraham Verghese, Center director and Marvin Forland Distinguished Professor. “I – and other physicians like Jerry – see it as a loss. Patients miss our doing that, the laying of hands.
“Also, a physician who does this is typically ahead of a physician who doesn't. If you physically examine a patient, you know a spleen is enlarged. You don't have to wait for the X-ray to come back.”
Founded in 2002, the Center has designed four years of humanities courses for UT Health Science Center at San Antonio 's medical students as an integral part of their curriculum. In their first year, students consider ethical principles and decision-making and are exposed to films and other narratives about illness. The following year, they focus on works of art relevant to the organ systems they are studying. In their third year, they explore medical humanities and ethics in lectures, presentations and small-group discussions, and in their fourth and final year, they focus on physicians' and cultural values and attitudes, the moral traditions of medicine, and the personal identity of doctors.
To Dr. Verghese, who is also the well-known author of the memoirs My Own Country and The Tennis Partner, medicine has always been about story-telling. By emphasizing stories and narratives in the Center's curriculum, he said, students learn to preserve the empathy and compassion they bring to medical school, their “capacity to imagine the suffering of others.” They are less likely to depersonalize patients by treating illnesses, instead of human beings.
As Dr. Verghese and Therese Jones, the Center's associate director, write, the Center's goal is for students to “become ethical, empathic and educated physicians, the kind of doctor one would be proud to have for one's self and one's family.”
Traditionally, Dr. Winakur said, “medical education has been a dehumanizing, not a humanizing experience. So we attempt – the Center attempts – to give students permission to listen to their gut and the voice of their unconscious and not be afraid to say, when confronted by mentors who are insensitive or arrogant to the patient's circumstances, to say – out loud, if necessary, ‘This is not right. This is a violation of ethical principles. This is wrong.'"
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