Welcome to this week's edition of Dear Dr. Horton. Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!
Dear Dr. Horton,
I've experienced the death of patients before — but this one feels different. I can’t help but think of small things we spoke about, like their dogs and their season tickets to the theatre. How do you navigate the intersection of professionalism and mourning another human you felt connected to?
Hilary Drake is a medical student in the Class of 2021 at the University of British Columbia
On my first day in a new family practice, my preceptor asked me to take a history from a patient who had listed their “reason for visit” as a sore throat. I stood in the hallway and made a mental checklist of questions to ask and observations to make. Have they had any sick contacts? Does their voice sound hoarse?
When I opened the door and asked them if they could tell me what brought them in today, they responded as expected: “My throat is sore.” When I asked what they thought might be causing the pain, they unwrapped a scarf from their neck and stated, “I think it’s because the noose didn’t work.” At that point they started crying.
They had tried to come in before. They had recognized their pain and wanted to reach out for help, but they were unable to out of fear that their physician would not believe the pain if they could not see it.
Rebecca Lauwers is a medical student in the Class of 2019 at McMaster University
Empathy as invited, first. Still it knocks. Waits. Empathy sees the fogged glass but drags no fingertip across it. There is a grey field; can you, too, see suffering like a red coat in the distance, walking? Do not go charging. What is imposed is not empathy. Set the kettle on the stove. Stoke the fire.
Empathy as unattached. As tracking a runaway bride, who knows what it’s like to be in one moment Ready and the next hijacked by fear. Empathy as the lover who will follow anywhere... yet as fluid as the crowd that will part to allow for what must happen. Empathy as the veil acknowledging the ground it grazes, feeling out the terrain as it follows.
Empathy as seeing it all, somehow, at once. Guided by someone whose vision will narrow and widen and narrow, and — somehow — letting each momentary glimpse be the only thing it sees while watching still over shoulders, overhead. ...continue reading →
Julian Nguyen is a medical student in the Class of 2019 at McGill University
Monday morning; flu season. The attending respirologist has spent the whole weekend on call battling the symptoms of influenza, likely caught from one of our many afflicted patients. Swallowing a Tamiflu pill, he tells me how—despite a hectic shift in the emergency room—he managed to complete a major grant application for his next research project. His voice is hoarse from coughing and exhaustion lies around the corner, yet his determination to carry on is unshaken. I admire his fortitude while hating myself for lacking his sense of sacrifice.
Michel Foucault, in his seminal Naissance de la clinique (The Birth of the Clinic), highlights the primordial role physicians occupy in a society predicated on science. He sees in physicians (and priests) “les héritiers naturels des deux plus visibles missions de l’Église — la consolation des âmes et l’allègement des souffrances” (the natural heirs of the two most visible missions of the Church — the consolation of souls and the lessening of suffering). Western society’s obsession with youth and health has elevated physicians beyond mere technicians to all-encompassing healers, increasing the burden placed on aspiring doctors. ...continue reading →
Sarah Hanafi is a Psychiatry Resident (R1) at McGill University
I started my Geriatrics rotation on the Restorative Care unit. Having trained mostly in acute care, I found myself perplexed by this care model. On the surface, many patients seemed to suffer from maladaptive personality traits that hindered their graduation to primary care. It felt like a bizarre blend between an internal medicine ward and a long-term care facility; this mirrored the disorientation I felt in managing patients who had few medical problems, per se, but lacked the means — whether intrinsic or extrinsic — to cope. ...continue reading →
Alexia De Simone is a medical student in the Class of 2021 at McGill University
In our first year of medicine at McGill University, each student is paired with a member of the community who has had an experience navigating the healthcare system. Upon meeting Mr. H, a 62-year-old man from Montreal, I expected to quickly understand the chronic pathology leading to his kidney transplant while discussing his co-morbidities and medications based on my first-year courses. However, after visiting Mr. H, I learned that medicine goes beyond a patient’s diagnosis, and that illness impacts many people in one’s life — including mine.
As part of our course, we were responsible for meeting our patient four times throughout the year. Initially, it was very challenging to elicit Mr. H’s perspective on how his illness had altered his life. ...continue reading →
The HIV/AIDS Care Unit (Unit 371) at Chicago’s Illinois Masonic Medical Centre was founded on a heartbreakingly simple observation. “We are all just people taking turns being sick,” stated Dr. David Blatt, one of the founders of Unit 371, in MK Czerwiec’s newest graphic novel — the aptly named Taking Turns: Stories from the HIV/AIDS Care Unit 371. Czerwiec was a brand-new nursing graduate on 371 during the height of the HIV epidemic, and Taking Turns is in many ways her tribute to the unit’s extraordinary spirit. The intention of the unit was made clear from day one: this would be a place where the most stigmatized and ostracized patients could be cared for with empathy, understanding, and love. ...continue reading →
Rising awareness of the toll that physician burnout is taking on our profession and our healthcare services has inspired numerous organizational physician wellness initiatives and resilience courses aimed at individual physicians. Yet, as experts discuss the relative merits of the system-level approach vs. the individual-wellness-training approach to addressing burnout, one key element seems to be all-but ignored: the healing power of the relationship between physicians and the patients they serve.
Dr. Tom Hutchinson, in his book, Whole Person Care: Transforming Healthcare (Springer International Publishing AG, 2017), suggests that we have lost touch with “the interior processes of healing and growth in the individual patient and the practitioner that give meaning to illness and to healthcare,” ...continue reading →
Robbie Sparrow is a medical student in the Class of 2019 at Western University
For individuals facing deep personal struggles, the path to recovery is often daunting and overwhelming. Support from others who have overcome similar challenges can be extremely beneficial. For example, the best people to help heroin addicts are those who have fought to stay sober for two years, and women facing domestic abuse are best aided by women who have escaped it. Doctors who care for patients living through crises are often disadvantaged when trying to empathize with them because they themselves haven’t faced the same struggle. Difficult experiences throughout a physicians’ life can help them approach this ideal of empathy and improve the care they offer patients. ...continue reading →
Kayla Simms is a Psychiatry Resident (R1) at McMaster University who graduated from medical school at the University of Ottawa in 2017
Compartmentalization is to medical knowledge as bread is to butter: patients, divided into sub-types; the body, separated by systems; the physician, detached from the pain.
Or so I once thought.
In medical school, I walked into patients’ rooms and stood idly at the bedside, intimately embedding myself into the darkest spaces of strangers’ lives. The bedside, like a carpenter’s work bench, is where I mastered concepts of sound and touch: the absence of bowel sounds auscultated in an obstructed state. The warmth of inflammation against the back of my hand.
The bedside is where I grew accustomed to asking questions like, “How is your pain today?” and learned to de-humanize the experience with the help of a 10-point scale. ...continue reading →