Culture and Art in Medicine
Authors’ full creative energy in the format of narrative medicine, opinion pieces, or poetry.
Resilience
Kassandra Corona
The University of Texas Medical Branch–John Sealy School of Medicine 
Sedimentation begins with the gravitational pull of the still water overlying the surface and thus bringing with it pieces of broken rock. The large pieces of rock weather down into smaller pieces, and as this continues the small rock deposits begin to form layers. Once the water comes out of the layers, they are compacted together. Much like the process of sedimentation is the process of overcoming difficulties we face. In medicine, we are faced with diagnoses that can shake the foundation on which we stand. It begins with tears and the confusion of who we once were, a feeling of brokenness. However, over time, by healing, the layers become part of our story of overcoming and growing through the adversity we face. What once felt broken creates a stronger person of overcoming mental or physical illness, survivors.
The Price We Pay
Cynthia Okafor
The University of Texas Medical Branch–John Sealy School of Medicine
Oh what a noble cause
It is to practice medicine
But, at what cost?
Oh the joy it brings
To relieve patient's pain
But, at what cost?
Oh the power of teamwork
To achieve utmost patient satisfaction
But, at what cost?
Oh the rewarding gift of perseverance
In the face of challenges
But, at what cost?
Surely, medicine is a noble cause---
A cause that perpetually gives and keeps on giving
But, at what cost?
Levántense: Get Up
Cynthia Okafor
The University of Texas Medical Branch–John Sealy School of Medicine
Get up and walk
Walk away from negative thoughts
Part ways with unhealthy habits
Say goodbye to toxic relationships
Get up and walk
Walk away from crippling doubts and fears
Dressed up as valid excuses
And never look back
Get up and walk
Walk into positive thoughts
And new habits that will
Catapult you to greater heights
Get up and walk
Walk towards those that love you
Those that appreciate you
And embrace your uniqueness
Get up and walk
The time is now
The time has come
Levántense.
Yesterday, Today, and Tomorrow
Christopher Doan
The University of Texas Medical Branch–John Sealy School of Medicine
Last fall, my younger friend and cousin died abruptly. He had a promising future and aspirations to become a physician's assistant. I have no doubt that he would have served his patients well. He was cherished in our community, and it was not until he had passed that we realized the true impact he made.
At his funeral, I looked around at a crowd of what must have been a thousand people. An epiphany came over me at that moment, pointing me towards the here and the now - the unfathomable present.
This photograph is inspired by my cousin's work in photography and a tribute that I have done in his memory. The left side of the photo highlights the joy and fullness of life, the happiness of a past life. The right side symbolizes the seeming emptiness of death, the closing of a once bright future. I chose to make the transition between color and black and white very abrupt, symbolizing my cousin's own harsh and sudden ending to his story. The flowers, both in the foreground and in the model's hands, also symbolize this transition. The seated person is blinded, pointing to how blind we are to our own present reality.
There is hope on the right side of the photo, though. While my cousin is gone, he leaves behind a legacy of kindness. This is represented by the stethoscope, a universal symbol of healing, and the graduation cap, a promise for excellence.
Lord let me die with a hammer in my hand
—confessions of a medical humanist
Woods Nash, Ph.D., M.P.H.
University of Houston–Tilman J. Fertitta Family College of Medicine
All day, wherever I go, I am clutching
a hammer. My main mistake is refusing
to wait for the winter-proof coat
of tenure. Late for the faculty meeting,
I hammer-punch elevator buttons—
my lone empirical contribution
to academic medicine. Colleagues
around the conference table gawk
like I’m a killer. But I’m not. I’m just a man
with a hammer: old and rugged
wooden handle, metal head sharp
and curved like it wants to be a rooster.
Typing with it now isn’t easy—pecking
each individual key. Most days I wish
I were John Henry, who could make
the cold steel ring. I would have miles
of tracks to lay down, a long tunnel
to wrest from the mountain
one momentous stone at a time.
Standing deep inside, I’d be safe
from the erasing blizzard. Diego Rivera
would paint me a mural. But Rivera
is very dead. So I use my hammer
to gesture in lecture, to dismantle
the students’ sensible questions.
In the hospital cafeteria, with my claw end,
I lift the weightless ramen noodles.
And later, playing ping-pong with Winston,
the awkward hammer is again my downfall.
If your only tool is a hammer, somebody
somewhere once said, you’re destined
to see everything as a nail. But I
haven’t noticed a nail in years—
not since the summer I was a Christian
and pitched in to build six houses.
This was in the hills of ransacked Appalachia,
where you’re never far from the plucky sadness
of banjo, guitar, and hammer dulcimer.
Coal trains crossing the Cumberland River.
Our twelve-person crew did it all: foundation,
roof, walls. And at each day’s end, overcome
by fatigue, sleep was a dreamless oblivion.
But I don’t think I could sleep tonight,
not with this hammer hunched under my pillow.
So I’ll stay awake and keep on typing, tapping—
make something to take me to the end of the line.
Smoking Among Healthcare Professionals and Their Influence on Texas Smokers
Michelle Chan Sanchez and Shirley Chan Sanchez
The University of Texas Medical Branch–John Sealy School of Medicine
Healthcare providers are supposed to be one of the top advocates for smoking cessation, right? Well, the number of physicians still using cigarettes is quite startling, with a prevalence of 21% of physicians that are current smokers worldwide (Besson et al., 2021). From 2010 to 2011, 8.34% of all healthcare professionals reported being current smokers (Sarna et al., 2014). There is no current data on cigarette smoking among healthcare workers within Texas, but with as much as 13.2% of the state population being smokers in 2020, it is a worthwhile topic to discuss (America’s Health Ranking [AHR], 2020). Healthcare professionals acquire extensive knowledge about the negative health outcomes of smoking throughout their training. So, why are these numbers shockingly high? How can this affect the manner by which cessation programs are presented to patients?
Healthcare workers have one of the most stressful careers; in addition to indirectly determining the health outcomes of their patients, working long hours, frequent patient charting and note completion, and high overall occupational stress, they are also responsible for their own mental and physical wellbeing (Ramos et al., 2018). This is where smoking prevalence can be understood, as it provides the means for de-stressing and comfort. Other factors that influence physicians to smoke are working night shifts, disruption of the circadian rhythm via shift work, long durations of stress that lead to depressive symptoms, and the acceptance of smoking in the culture or regional area (Besson et al., 2021; Giorgio et al., 2015; Pipe et al., 2009). The reasons for smoking are multifactorial, making it difficult for interventions to be designed. But, before delving into program planning, physician-smoker and patient interaction outcomes should be assessed.
Are current-smoking healthcare workers just as inclined to address smoking concerns or smoking cessation programs to their patients compared to non-smoking physicians? One study conducted across 16 countries assessed the use of tobacco among general and family practitioners and how they would address smoking cessation programs to their patients. Compared to non-smoking physicians, smoking physicians were less likely to discuss smoking cessation programs with their patients, less likely to believe that smoking posed a significant threat to patient health, and less likely to continue consultation activities to directly assist smokers to quit (Pipe et al., 2009). These physician smokers were more likely to perceive further barriers to helping their patients quit smoking. This included patient willpower, a stressful environment, increased workload, low success rate, and enjoyment of smoking (Pipe et al., 2009). If we looked into a country where the smoking prevalence is high that is also made up of the healthcare workforce, we can focus on Italy (Besson et al., 2021; Giorgi et al., 2015). A hospital in central Italy, a country with high smoking prevalence amongst its healthcare workforce, found that 47% of physicians and 43% of nurses were current smokers. Some of the major findings were that, of the smokers, only 47.4% believed that the behaviors of health workers are seen as role models by patients, and only 54.1% believed that smoking is the most important preventable cause of death in industrialized countries (Giorgi et al., 2015). These numbers are quite shocking, as one would believe that healthcare professionals would be highly conscious of how their words and actions can greatly influence patient behavior and its role as a risk factor for countless diseases. A healthcare professional's perception, education, and experience with cigarettes can alter and influence the path and progression of a current-smoking patient’s health or disease. These are important factors to consider as new tobacco products are growing in popularity among young adults.
We should also examine the emergence of e-cigarette usage among young adults, including healthcare professional students (Besson et al., 2021). As much as 5.2% of adults in Texas were current e-cigarette users in 2020, including college and health professional students (AHR, 2020; Sarna et al., 2014). Health professional students’ usage and perspective of e-cigarettes will pave the way for how smoking cessation programs will play out in future clinical settings. One study in 2018 from the University of Minnesota Medical School looked into medical students’ knowledge, perspective, and usage of e-cigarettes. Some of the key findings from the study showed that 14.7% of the participants have already tried an e-cigarette, 84.7% stated they have not received any education about e-cigarettes, and those who were current e-cigarette users believed that e-cigarettes had a lower risk of causing lung cancer and were more likely to recommend e-cigarettes to patients for smoking cessation (Hinderaker et al., 2018). A study conducted at the New York University School of Medicine found that 14.8% of students reported currently using cigarettes or an alternative tobacco product (ATP), a small percentage of students were able to correctly report the potential harm of ATPs compared to cigarettes, and a majority of respondents reported receiving significantly less education about ATPs compared to cigarettes (Zhou et al., 2015). According to the National Youth Tobacco Survey for 2022, 14.1% of high school students, and 3.3% of middle school students reported current e-cigarette use (U.S. Food and Drug Administration, 2022). These studies raise concerns about health outcomes that may be presented in the near future, as the health effects of such products will become more pronounced. The usage and lack of education on e-cigarettes in healthcare professional schools could lead to unique repercussions when educating and providing smoking cessation programs to future patients who do not represent the traditional cigarette user.
Although the amount of current-smoking healthcare professionals is lower in the US compared to other countries, the observations mentioned are still important to consider if we want to deliver the best care to our population (Sarna et al., 2014; Besson et al., 2021). Tobacco products have been shown to be frequently and strongly correlated to harming nearly every organ in the body; it is linked to heart disease, kidney disease, liver disease, lung disease, stroke, cancer, and much more (Carter et al., 2015). In Texas, a state where 13.2% of the population smokes, it would be valuable to provide this patient population with healthcare professionals who are knowledgeable about the negative consequences of varying tobacco products, willing and consistent in discussing smoking habits and cessation programs, and cognizant of their position and influence towards patients. The first step to tackling the problems presented is to acknowledge the high prevalence of smoking among healthcare professionals—focusing on the lack of current information allows us to create opportunities to better learn about smoking among all Texans, including healthcare professionals.
References
America’s Health Rankings (AHR). (2020). Explore Smoking in Texas: 2021 Annual Report. Retrieved September 12, 2022 from https://www.americashealthrankings.org/explore/annual/measure/Smoking/state/TX
Besson, A., Tarpin, A., Flaudias, V., Brousse, G., Laporte, C., Benson, A., Navel, V., Bouillon-Minois, J.B., & Dutheil, F. (2021). Smoking Prevalence among Physicians: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 18(24), 13328. https://doi.org/10.3390%2Fijerph182413328
Carter, B.D., Abnet, C.C., Feskanich, D., Freedman, N.D., Hartge, P., Lewis, C.E., Ockene, J.K., Prentice, R.L., Speizer, F.E., Thun, M.J., & Jacobs, E.J. (2015). Smoking and Mortality—Beyond Established Causes. The New England Journal of Medicine, 372(7), 631-640. https://doi.org/10.1056/nejmsa1407211
Giorgi, E., Marani, A., Salvati, O., Mangiaracina, G., Prestigiacomo, C., Osborn, J. F., & Cattaruzza,M.S. (2015). Towards a smoke-free hospital: how the smoking status of health professionals influences their knowledge, attitude and clinical activity. Results from a hospital in central Italy. Annali di igiene: medicina preventiva e di comunita, 27(2), 447- 459. https://doi.org/10.7416/ai.2015.2031
Hinderaker, K., Power, D. V., Allen, S., Parker, E., & Okuyemi, K. (2018). What do medical students know about e-cigarettes? A cross-sectional survey from one US medical school. BMC Medical Education, 18(1), 1-7. https://doi.org/10.1186/s12909-018-1134-1
Pipe, A., Sorensen, M., & Reid, R. (2009). Physician smoking status, attitudes toward smoking, and cessation advice to patients: An international survey. Patient Education and Counseling, 74(1), 118-123. https://doi.org/10.1016/j.pec.2008.07.042
Ramos, S.D., Kelly, M., & Schepis, T. (2018). Substance Use in Healthcare Workers: Importance of Stress Perception, Smoking Temptation, Social Support, and Humor. Substance Use & Misuse, 53(5), 837-843. https://doi.org/10.1080/10826084.2017.1388261
Sarna L., Bialous S.A., Nandy K., Antonio A.L.M., & Yang Q. Changes in Smoking Prevalences Among Health Care Professionals From 2003 to 2010-2011. Journal of the American Medical Association. 2014;311(2):197–199. https://doi.org/10.1001/jama.2013.284871
U.S. Food and Drug Administration. (2022). Results from the Annual National Youth Tobacco Survey (NYTS). Retrieved October 30, 2022 from https://www.fda.gov/tobacco-products/youth-and-tobacco/results-annual-national-youth-tobacco-survey
Zhou, S., Van Devanter, N., Fenstermaker, M., Cawkwell, P., Sherman, S., & Weitzman, M. (2015). A Study of the Use, Knowledge, and Beliefs About Cigarettes and Alternative Tobacco Products Among Students at One U.S. Medical School. Academic Medicine: Journal of the Association of American Medical Colleges, 90(12), 1713. https://doi.org/10.1097%2FACM.0000000000000873
IMPACT
Diamondneshay Ward
University of Houston–Tilman J. Fertitta Family College of Medicine
His beady eyes pierced my soul. At that moment, I swear I saw a glimpse of his, too. "Dr. Ward ... what do you think?" He knew I was a student but insisted on calling me "doctor." It was a sign of not only respect, but trust.
His hospital course streamed through the riverbanks of my mind.
The last week of my inpatient internal medicine rotation had arrived, and I had grown fond of a patient. He presented ten days prior due to a fall. He was an elderly, weak man, so frail that I initially hesitated to do my physical exam, fearing I might be too rough and hurt him.
Due to his initial confusion, obtaining a history was challenging. As he stabilized over the next few days, I spoke with him. Together, we traveled to the past in a time machine. I knew his nicknames, previous life experiences, and deepest fears. Eventually, the residents informed me there was nothing more to learn from his case, and my patient list changed. In the following days, I arrived even earlier than before to make time for my new patients and my old friend.
And now, he gazed. His eyes—his eyes pierced my soul. "Dr. Ward?" he repeated. He sought out my opinion about his next step of care, and I was honored. I had already researched rehabilitation facilities in anticipation of his next moves and was able to provide my genuine, honest, and informed perspective. "I think that's a great idea…." I began and explained my reasoning. He nodded, looked at the other providers and family members in the room, and agreed. I realized that he was waiting on me. He wanted me involved in his care.
On the last day of my rotation, I said my final goodbye. A solemn song played on a phonograph in my mind.
But, like falling leaves marks the end of one season and the beginning of another, I knew it was time for a change.
I hope I never forget his voice. I wish to see his beady eyes forever and ever.
Seasons change. Leaves fall, and flowers bloom. New becomes old and old; new.
But IMPACT is eternal.
Thank God for Good Residents
Anthony Carona, Ph.L.
University of Houston–Tilman J. Fertitta Family College of Medicine
I don’t think I’ll ever forget my first week of clerkship – the time in every would-be-doctor’s medical school career where he transitions from a hunchbacked memorizer of textbooks into a hospital wallflower with actual, if elementary, patient care responsibilities. After a year and a half of lecture-based learning (and the associated mountains of memorized facts) to say I was excited would be an understatement. I signed up for medical school to care for patients, and in clerkship I’d finally be able to.
It didn’t take long, however, for excitement to turn to dread as my alarm blared at 4:00 a.m. on the Monday of my first day. With most the world and half my brain still asleep, I could hardly remember brushing my teeth, donning my hospital-issued soap green scrubs (2X’s too large), or even starting my car by the time I got to the hospital. I remember the feeling of a widening pit beneath my stomach when I saw the harshly illuminated sign directing me to the correct department. Perhaps it was fear overtaking me on day one as I realized I didn’t know a thing about obstetrics and gynecology – my home away from home for the next several weeks.
I was greeted without ceremony by a weary-eyed resident who, in a motion that did nothing to relieve my anxieties, indicated that I’d be following her around for the week. She escorted me to a windowless room where all the other residents and attendings had gathered to “give report.” It was shift-change, and it proceeded according to a ceremonial that was as foreign to me as any ancient rite. I was lost as residents read out their patient lists complete with lab values and countless unfamiliar abbreviations. I took my seat at the end of the horseshoe-shaped table; I soon after learned that even the seats had been hierarchically arranged.
A few minutes in I began to feel the heaviness of my eyebrows increase. The room was unsettlingly warm. Terrified at the thought of being caught dozing, I tried a number of tricks, including biting my own tongue, to stay awake. It was futile - until BAM! My bobbing head had just been sent back reeling by my own vigilant neck. Suddenly I was wide awake with heart pounding and panicked that someone had seen me fall asleep. I scanned the faces in the room surreptitiously and, as an initial clue of their humanity, was relieved to see that half the residents (and some attendings too!) had their eyes softly shut.
Over the next several weeks it would be my privilege to glimpse even more signs of the humanity of these doctors. Where my own insecurities in this new environment had made them seem aloof and unapproachable, they tore down these barriers with patience and kindness. They showed me how I could be helpful, and I was truly made to feel like one of the team. Like me, the residents were still learners, and like me they still had moments of self-questioning and uncertainty.
The standard medical student task on labor and delivery is to deliver the placenta. It’s not particularly glamorous nor challenging work; left to their own devices, most placentae will deliver themselves. Nevertheless, after any successful delivery of a baby, it fell to me to apply gentle traction to the umbilical cord via a pair of forceps and ensure that the slimy, pancake shaped organ exited the birth canal in one piece. This procedure carried on well throughout my rotation, until one day it didn’t.
Things began normally – as had happened many times before, my team was summoned to the delivery room. After the residents had successfully delivered the baby, who now rested on her exhausted mother’s chest, the clamped umbilical cord was handed to me. I pulled back slightly on the forceps until the cord was taught – behind me I could hear the attending physician advise me with a whisper, “gently… gently.” To this day I still don’t know if it was overconfidence or just bad luck, but in the blink of an eye I heard a damp snap and watched the gelatinous cord sever and recede back into the patient without even a glimpse of it left behind. Instantaneously, I felt the same pit widening beneath my stomach as on the first day. My gloved hands began to tremble. I was quickly scuttled away by the residents, one of whom prepared to manually extract the lost placenta while the other gently explained to the patient what was about to occur. “I’m sorry, I’m sorry,” I muttered to the attending as I watched the bloody and uncomfortable task that ensued. Within a couple of minutes, the placenta had been secured and successfully extracted. The residents, scrubs bloodied by the urgent procedure, cautiously examined the organ to make sure no pieces were missing. Ultimately, my ego was the only one harmed.
I was filled with dread on the walk back to the work room. I kept my head down, fully expecting to receive a tongue-lashing from the entire team. When that didn’t happen, I apologized again for my mistake, this time profusely. Rather than a scourging, I received unexpected clemency. “No need to apologize,” the attending said, and continued on to list the variant anatomies that can contribute to an umbilical cord avulsion. “Yeah, it’s happened to all of us,” one resident assured me. Encouraged, but still shaken, I left to change my scrubs.
I remain grateful for my experience in Obstetrics and Gynecology. Apart from this episode, I was edified daily by hearing the residents share their joys and sorrows, hopes and frustrations as they labored to provide the best for their patients. It’s too rare that doctors – residents or attendings – willingly share their mistakes with others. Now I realize how crucial it is. Without that self-avowal, we’re left with unrealistic expectations and constant feelings of inadequacy, but with openness and honesty, we create a much more accommodating system, especially for our peers still in training.
An Honor I Never Wanted… and Didn’t Deserve
David Jacobson
University of Houston–Tilman J. Fertitta Family College of Medicine
“It is an honor to be present at the time of death.” I was 18, sitting in my EMT class getting my first glimpse into medicine. I had never seen someone pass before; it seemed like anything but an honor. Death was something I feared, something that I was getting into medicine to fight. I knew death was an unbeatable foe but there would be honor in fighting death. Sitting nearby while Death wins, there is no honor there, it would mean we lost that fight.
A few weeks later, I started my first clinical rotation. My first ever call while working on the ambulance was a call for an unresponsive person. This was it; I was going to the big show. My heart raced, I was excited to have a chance to make a difference, but terrified of what I may see. When I got there, the family was crying, pleading with us to “do something.” I got to work and started CPR. I felt his ribs break under the weight of my arms as I started compressions. My professors had warned me that this was a normal occurrence so luckily, I was not caught off guard. What caught me off guard was the feeling of bones breaking in my hands, the crunch that rang in my ears for the rest of the day. Nothing could have prepared me for that. A few minutes after doing everything we could, we called medical control, and they pronounced the patient dead. This was the first person who had died in my presence, and I was anything but honored. I was dejected, unsettled by the harsh reality of CPR and uncomfortable being surrounded by grieving family members with no way to comfort them. This wasn’t an honor. This was torture. We stayed with the family for a few minutes trying to get them to focus long enough to get information for our report. I felt like an outsider, intruding on what should have been a very private time for the family to comfort each other.
More recently, my wife and I experienced a devastating loss. We adopted a child, Travis, who passed in the NICU before we ever got to bring him home. It was only then that I understood what my instructor meant by “it’s an honor to be present at the time of death.” It is not an honor that we should feel grateful for, but it is a huge responsibility that is extended to us. There were two types of healthcare providers that we interacted with in Travis’ last hours. There were some that drew near to us and were allowed into our lives. Without knowing them, we allowed them to share in our sorrow. They saw parts of us that were, and continue to be, hidden from the rest of the world. There is a raw honesty in experiencing sorrow and based only on their position as healthcare providers, we let them in and shared our most vulnerable emotions with them.
Contrasted to the healthcare providers who were there to offer comfort during our despair, there were others who were visibly uncomfortable with our emotions. Instead of talking to us, they stood distant from us. They would come in to check on us but not interact with us; they would just watch us for a few minutes and leave. I cannot express how intrusive this was. We had no choice but to invite them into our most exposed moments only to have them reject us by standing out of reach, physically and emotionally.
This illustrates the honor that is bestowed upon healthcare providers. That by nature of our profession alone, people allow us to be there for them during their most vulnerable times, something reserved for family and closest friends. However, I want to share that this honor is accompanied by mighty responsibility. I write this to illustrate the opportunity that is given to us in people’s last moments and encourage everyone to embrace the discomfort of death. Draw near to your patients and see the opportunity for what it is, a great honor.
Listening Dispels Distrust
Rosemary Agwuncha
University of Houston–Tilman J. Fertitta Family College of Medicine
There is something deeply sacred about the trust a patient places in their provider. Some moments will forever be etched into my memory. While obtaining this young Black man’s history, he told me about his struggles with depression that led to excessive alcohol intake throughout college and grad school. This was only exacerbated during the pandemic. He avoided eye contact as he sheepishly admitted with a tinge of shame and regret that he knew it wasn’t good for his health, but he had become so accustomed to drinking 10-14 shots of hard liquor every night to make it through, that he couldn’t imagine coping any other way. I asked if he had ever followed up with someone to navigate his concerns with his mental health, and he mentioned that he was supposed to, but never did.
I was taken aback at how much he trusted me, even after I made a grave med student mistake a few moments earlier. While reviewing his medical history with him, I asked how things were going with his kidney disease. Then, there was silence. Finally, the patient looked at me in confusion for a few moments and asked, “What kidney disease?” Only for me to look at the chart’s adjacent column and realize that my preceptor had just added that diagnosis today based on the patient’s most recent labs.
I quickly tried to backtrack and said I was not sure about that diagnosis, that I had possibly made a mistake, and the doctor could confirm shortly if that was meant to be in his chart. I then skipped over what appeared to be a new diagnosis of diabetes that was right underneath and went on to obtaining the rest of the medical history and completing the physical exam.
I reported the information I had collected to my preceptor, and sure enough because the clinic had been moving so quickly that day, she wasn’t able to tell me earlier that she planned to confirm these two new diagnoses today with this young man.
We walked into the room together, and shortly after the formalities, she went ahead to the main item of business for the visit: “I wanted to go over your most recent labs with you.”
He said, “Yeah, she said something about kidney disease? How did that get in my chart? Was that a mistake?”
She replied, “Well according to your GFR and creatinine levels, you actually have what we would call stage 3 kidney disease, and your blood sugar levels are now in the official range for diabetes as well.”
He looked devastated and distraught. She continued on to share how each of the remaining lab values were normal. I interjected afterwards, “I know that was a lot to take in. How are you feeling? What questions do you have?” He said he was trying to take it all in and needed a few moments to think, but he would tell us once he had questions. So, my preceptor proceeded with the physical exam. After that, she gave him some education about lifestyle modifications and told him when to return for a follow up appointment, then bid him farewell and left the room.
Without even asking permission, I stayed and pulled up a seat and asked him once again, “I know that was a lot to take in. What questions do you have?” I was a little nervous because I knew I probably should help the workflow by moving on to go see the next patient, but I felt like leaving this patient in this overwhelming state of shock and confusion would be a disservice.
He thanked me for really taking the time to listen and speak with him because usually he feels rushed, and he admitted that he didn’t always feel his doctor was listening to him. I told him that I was sorry to hear he felt that way, and that I would be glad to take the time to answer whatever questions he might have, even though in the back of my mind I felt inadequate to answer the intricate details of all the pathophysiology and treatment for CKD.
I told him as much as I knew, and with the internet’s help, we looked up more information and looked at different graphics that helped him understand the diagnosis more in depth; what lifestyle modifications would be important to make, following up with psychiatry, and what treatment options he would have to consider if those modifications fell short of managing the disease. Then, we talked a little bit about his support system, his perceived barriers to making these lifestyle changes, possibly channeling energy and time into cooking for his friends so they could be social without going to bars, and discussed considering Alcoholics Anonymous.
At the end of our conversation, he expressed gratitude, and that on many occasions he felt unheard by his doctors. I thanked him for trusting me to have this conversation with him and told him I would excuse myself to go see the next patient. He was shocked that I was supposed to be seeing other people but decided to spend so much extra time talking to him, so he thanked me again. I shared that it was truly a pleasure to do so, offered some encouragement, and wished him the best of luck before excusing myself from the room.
I know that the amount of extra time I took won’t be realistic to do when I become an attending physician, but it allowed me to take a step back and treasure the unique opportunities I have as a medical student; to really contribute something meaningful to the team and to the patient’s care. I was nervous to find my preceptor afterwards because I figured she would’ve wanted me to see more patients. Instead, she genuinely thanked me for taking the time to talk with that patient because she knew he needed extra time, but that she had other patients waiting on her.
It was special to reassure this young Black man, who was previously feeling some level of distrust, that his healthcare team truly had a vested interest in supporting him to improve his overall wellbeing and quality of life. For me, the moment provided positive reinforcement to continue striving to become an empathetic physician who listens well, even when the busyness and stress of the job tempts you to do otherwise.
All patients, especially minority patients, desperately need to feel heard, otherwise they end up losing trust and motivation to engage with the healthcare system, diminishing the efficacy of our efforts and the efforts of any other future healthcare providers they may encounter. I will strive to always remember that listening dispels distrust and is central to building relationships with patients.