09/10/08

 

BY TRACIE WHITE

	Jonathan Kleinman
	First-year medical students celebrate after a hike during an Aug. 20-23 camping trip in the Carson-Iceberg Wilderness in the Sierra Nevadas. After the trip, the students came to the campus for orientation sessions.

During the outbreak of the AIDS epidemic in the 1980s, doctors faced their patients empty-handed. There were no treatments, no drugs, no cures. Technology provided no answers.

“We really had nothing to offer them except ourselves,” said Abraham Verghese, MD, Stanford professor of infectious disease, best-selling author, champion of hands-on medicine and the keynote speaker at this year's orientation for new medical students. “But we had everything to offer by being there for them, by helping them come to terms with their illness. We were forced to relearn the lessons of the horse-and-buggy days.”

Verghese’s heartbreaking personal story of witnessing the emergence of AIDS in the small town of Johnson City, Tenn., told in his book My Own Country, led off the orientation for the School of Medicine’s newest crop of medical students. This year’s sessions were designed to emphasize the importance of the human side of doctoring.

Orientation began Aug. 25 on the heels of the annual student-organized camping trip and ended Aug. 27 with the traditional alumni-sponsored “stethoscope ceremony,” at which the new students receive their personalized stethoscopes, symbolizing the importance of the physical connection between doctor and patient. Classes began Aug. 28.

The orientation’s emphasis on professionalism and humanity was designed in response to disturbing trends in the practice of medicine that include an ever-growing reliance on technology at the expense of human relationships and dwindling consultation time between doctors and patients, medical educators said.

“Are we to expect to have time with patients?” one medical student asked during the sessions.

“The system is tough, but you can change it,” said Charles Prober, MD, senior associate dean for medical education and professor of pediatrics and of microbiology and immunology.

Acknowledging the importance of technology, Prober told the room full of future doctors in the Clark Center auditorium that there is much to be learned from the early days of medicine, when house calls were routine.

	Char Hamada
	Professionalism and humanity were the focus of this year's orientation sessions for new medical students.

“You are in the privileged position of taking care of others,” Prober told the group of 86 students, chosen out of an application pool of 6,567. “We don’t want you to lose sight of what brought you here in the first place, the desire to be caring and compassionate doctors.”

Students face the threat of losing touch with that passion to care for patients after undergoing the intense years of training in medical school, Verghese said.

“By the third year, we’ve made you focus on disease,” he noted. “There is a danger of patients becoming ‘the heart attack in bed three,’ and ‘the diabetic foot in bed four.’”

“It’s easy to hide behind lab work and behind papers and statistics,” said first-year medical student Patricia Ortiz-Tello, who is pursing both medical and doctoral degrees. “I don’t want to lose the personal aspects of the doctor-patient relationship.”

The orientation format this year included the introduction of a new group of mentors called “Educators For Care” who will provide students with ongoing training in the doctor-patient relationship throughout their time at Stanford. These mentors, chosen from among the current faculty, will train the students in physical examination skills and other hands-on techniques. They’ll teach how to approach a patient with a thoughtful understanding of the patient’s history and expose students to actual clinical settings earlier on in their education than in past years.

“We want to make sure that the students have the time and opportunity to sit with their patients and listen and provide that special bedside therapy,” Prober said. “Over time, our hope is that this ‘back to the bedside’ movement will carry forward through residency and beyond.”

Verghese, whose book was sent to students along with a welcome letter prior to orientation, told students the story of how it was born.

As a new, small-town doctor in the Bible Belt treating many more AIDS patients than would have been predicted for a town that size, Verghese became aware that he was witnessing a phenomenon of migration. Hometown boys who had left years before and settled in the big cities of New York, San Francisco and Atlanta were returning to their rural homes in unanticipated numbers, often to die.

“These patients were in agony,” Verghese said. “They needed much more than what medicine had to offer.”

He first wrote about this migration in the Journal of Infectious Diseases, but “the cold, unimaginative language of science didn't begin to describe the heartache,” he said. In his memoir, he was able to reveal the human side of his patients’ suffering and the redemptive nature of being there at the bedside to help relieve that suffering.

This hands-on medicine didn’t provide a cure, but it helped heal the patient’s pain.

“You come to medicine with a tremendous capacity for empathy,” Verghese said. “You’re attuned to the suffering of others. Maintain that. Whenever I see a medical student weep when a patient dies, it heartens me.”

Verghese ended his address with the very words of advice that the patients in his book had for him: “Ladies and gentlemen, make good use of your time.”