On this episode of the Academic Medicine Podcast, Katherine Chretien, MD, Grant Wilson, MD, and Michelle York, MD, join host Toni Gallo to discuss building meaningful relationships with patients, the small but impactful ways they show their patients they care, and the important role that learners play in connecting with patients and contributing to their care.
This episode is now available through Apple Podcasts, Spotify, and anywhere else podcasts are available.
A transcript is below.
Check out the essay discussed in this episode.
- Read the essay: Chretien KC. Biopsy. Acad Med. 2023;98:1419.
- Listen to the author read her essay: Chretien KC. Biopsy. Academic Medicine Podcast. January 8, 2024.
Learn more about the Teaching and Learning Moments column.
- Each issue of Academic Medicine includes at least 1 Teaching and Learning Moments essay. These essays are always free to read.
- Read recent essays on academicmedicine.org, listen to the authors read their essays on the Academic Medicine Podcast, and submit your own writing for consideration through Editorial Manager.
- Academic Medicine accepts Teaching and Learning Moments submissions on a rolling basis. Learn more about the requirements for the column on academicmedicine.org.
Transcript
Toni Gallo:
Welcome to the Academic Medicine Podcast. I’m Toni Gallo. Many of you will be familiar with the Teaching and Learning Moments column in Academic Medicine. Each month we publish first-person narrative essays that chronicle a meaningful experience the author has had as a learner, teacher, clinician, caregiver, or patient, and what they learned from that experience that they hope others will learn too. These reflections often emphasize how the science and the art of practicing medicine intersect, and many of the authors have also read their essays on this podcast, so you’ve probably heard their voices here.
On today’s episode, I’m joined by Dr. Katherine Chretien, who authored one of these Teaching and Learning Moments essays entitled “Biopsy,” which was published in the December 2023 issue of Academic Medicine. Kathy also read her essay on an episode of this podcast in January. If you haven’t listened to that episode yet, definitely go back and find it in our archive or you can read Kathy’s essay at academicmedicine.org. Links to both are in the show notes for today’s episode.
I was really moved when I listened to Kathy reading her essay and I wanted to have her back on the podcast to talk about her experience, what inspired her to write this essay and a little bit about the themes that she talks about, themes around learners and teachers caring for patients together. And for our conversation today, we’re also joined by two of Kathy’s colleagues, Dr. Michelle York and Dr. Grant Wilson, and I want to jump right into our conversation, so let’s do some introductions. Kathy, could you get us started?
Katherine Chretien:
Sure, thanks Toni. I am Dr. Katherine Chretien. I’m Associate Dean for Medical Student Affairs and the Director of Medical Student Wellness at Johns Hopkins University School of Medicine. I’m a physician writer and I’ve done a lot of academic work in social media, wellbeing, as well as narrative medicine.
Toni Gallo:
Thank you. Grant?
Grant Wilson:
Hi, thanks so much for having me. I’m Dr. Grant Wilson. I am originally from Colorado, currently an intern in the Osler Internal Medicine Residency Program at Johns Hopkins. I also went here for medical school and have loved it here. I think it’s a really great learning environment. I’m interested in medical education, hospital medicine, and cardiology, so kind of narrowing down those interests. But part of why I’m here today is I think medical education is fascinating and really important to have a good experience there.
Toni Gallo:
Thanks for joining us. Michelle?
Michelle York:
Hi there. Thanks so much again for having us. I’m Michelle York. She/her pronouns. Great to be here. I am coming to Hopkins from Vanderbilt where I went for medical school and had the opportunity there to be inspired by so many humanistic mentors who inspired me to go into internal medicine and primary care. I’m a current PGY3 here in the Osler Medical Residency Program, also part of the Urban Health Primary Care Track. So planning to pursue a career in general medicine, primary care, and alongside these wonderful medical educators, planning to do some medical education within that career as well.
Toni Gallo:
I’m so glad you’re all here today for our conversation. Kathy, I want to turn to you first to just tell us a little bit about your essay, “Biopsy,” that we’re going to talk about. Tell us a little bit about the experience you write about and then what inspired you to actually put this into essay form.
Katherine Chretien:
Sure. So “Biopsy” describes my experience as a patient needing a biopsy of a mass and describes what’s happened with the actual procedure that was performed by a resident and was supervised by an attending at a teaching institution. I think as physicians in training and as practicing physicians, we always try to put ourselves in the shoes of our patients when we’re trying to take the best care of them, and I think we do a good job of that usually, trying to imagine the vulnerability that they experience. But when I was in those shoes and when it happened to me, I was flooded by these feelings of stress, anxiety, and fear in a way that it’s hard to imagine when you’re on the other side. And I felt this so acutely and thinking about how the interaction with the resident and the attending and me shaped those feelings in a positive way and I wanted to capture that in writing.
Toni Gallo:
There are a couple of quotes from your essay that really jumped out at me that I’m hoping we can discuss a little bit. The first one is … you write, “I tell the medical students I advise that the luckiest patients in the hospital are those that they are following. They bring their patients the gifts of time and attention.” And all of you hold different roles as learners, as teachers, as patients, and I wonder if you can just reflect on that quote and sort of what it means to you. What does that look like as a clinician in your experience? Anybody is welcome to jump in.
Katherine Chretien:
I mean, I can start. I think that presence and presence with patients is a gift to patient interactions. And sometimes the medical students who have the most time to spend with their patients, they don’t have as many in their patient load and they might be able to spend more time with them and able to advocate for them because they heard their stories and they witnessed that and they know what that patient is going through. However, I do think that all of us, whether we’re busy interns or supervising residents or practicing physicians, we all have that ability to bring presence to our interactions and it just takes awareness, like wanting to go there and being intentional about it.
I remember when I became a resident at the same institution, of how I suddenly felt like I had this space to do that. I could supervise a team and I could see those patients on our team that needed extra time because they were really struggling and being able to be the one to go there and spend some time at the bedside to explore those feelings that sometimes interrupted their patient care or how they felt about their care. So I think that presence is key and being able to devote that time and attention to patients is what we need to do at times.
Michelle York:
If I can jump in there, I just want to reiterate that you took the words right out of my mouth. Just hearing the quote from your article, my immediate thought was that it’s such a gift, both to have medical students on our team but also as you mentioned, to have the time and space and presence to be with patients. And we talk a lot and I think especially medical education these days about the factors that pull us away from the things that inspired us to go into medicine in the first place. And I think probably one of the most universal truths in medicine is that almost all of us went into this because of moments that we’d had with patients either being a patient, seeing a family member be a patient, or desiring that when shadowing or opportunities. Just saying, “That is what I want to do. That’s what brings me fulfillment.” And getting to see our medical students establish those relationships with our patients and become their preferred provider on a team has been one of the most rewarding experiences that I’ve had as a senior resident here.
I think truly the time is the game changer there. I was recently in our cardiac ICU and just hearing reflections from patients about the benefit of touch, the benefit of a warm look in somebody’s eyes, and how that inspired them to make it through a really tough night just goes to show that yes, medical knowledge of course is important, but being an asset to the team as being an advocate for your patient and being a person to your patient. So I think that this article really touches on how much medical students can impact patient care.
Grant Wilson:
Absolutely. Kind of just going off of that, I think being just on the other side of it now, having just been a medical student just over a year ago, I am just amazed by how much the value of that time that medical students have with patients is. Now being a busy intern, you see that med students will pick up on aspects of a patient’s care that you might not have caught. Maybe their social situation or the patient can open up to them even more and feel supported by them. And so I think having the perspective of the medical students to add to the whole team, their understanding of the patient often is so in depth because they have the time to spend with them, to talk with them, and really to comfort them. And you really just see that in when I go see the patients, you’ll see how much having that relationship with the medical student has helped the patients.
Toni Gallo:
This theme, we actually see it a lot in the Teaching and Learning Moments essays that are written by students, the experiences that they’re talking about are a time that they did get to spend, got to know a patient, got to know the patient’s family outside of maybe a treatment or diagnosis, just kind of the impact of that relationship that they were able to build. Michelle and Grant being closer to the learner side of things, could you just talk about what that was like for your practice and kind of development as a physician? What did that mean when you were able to spend that time to get to know a patient and their family? How did that help you in thinking about practicing medicine?
Grant Wilson:
I can start out, I think it’s really reminding me just to see the impact that illness can have on a patient’s life and just realize that it’s affecting them, it’s affecting their family members, and I think it’s so valuable to hear about their story, hear about what their life is like outside of the hospital, and it really humanizes them and helps you just see this illness or whatever they’re dealing with is putting a stop on their life for now and is really impactful. And so I remember one patient in particular in med school that I had the privilege to take care of for several weeks and really got to know him and his family. And it just was so meaningful to kind of walk with them step by step as he was getting better bit by bit. And I think taking that with me into residency now, it really reminds you to not get lost in all the details, all the lab work, the vital signs, but to remember the impact that this illness is having on that patient and to really work with them and their family to get them back to health.
Michelle York:
And I think just to build off of that, the humanistic interactions that my patients have gifted me throughout my medical training are the ones that have inspired me to keep going and to pursue this career in general medicine where I get to foster longitudinal relationships with my patients. It’s certainly impacted my career choices in terms of going into a field like primary care, which I think clinically is one of the most challenging spaces I’ve worked in, but relationship-wise is one of the most rewarding.
And so just to share, I think the biggest area as a medical student that this impacted me and really outlined that career path was in our student run free clinic. As a medical student there, I was able to not only get to know patients as people, I worked in our social work department, I got to know what the struggles were in their life. I didn’t just talk to them about what medications they were taking. I actually went to their homes and saw .. this person is babysitting their grandkids and also the kids down the road because they need childcare and childcare is expensive. And getting to know them as those people, getting to know and get to take care of their entire families was a huge part of why I went into medicine where I could see so many people of all different ages and care for families as their doctor. And so that kind of laid the foundation for me coming into the internal medicine residency.
And I think the other thing I just want to highlight is, before starting residency, one of my mentors in medical school was actually the Program Director at Vanderbilt Internal Medicine Residency. Dr. John McPherson told me a piece of advice that hopefully I can pass along to any listener, which is just that, residency days are long and sometimes they can challenge your memory of what really inspired you to go into medicine, but the thing that will always take you back is being at the bedside. And if you can every now and then, instead of just signing out and walking out of the hospital doors, sign out and go back and sit next to a patient. And yes, you’ll be in the hospital a little bit longer, but you’ll be reinvigorated and reminded of why you came into this field in the first place. So that, I hope, can inspire people to remember to come back to the bedside and remember why they started this to begin with.
Toni Gallo:
Thank you both for sharing about that. Kathy, what about you in thinking about either your role as a clinician or how you support students at your institution? How do you think about fostering these sorts of relationships between students and their patients?
Katherine Chretien:
I think it’s those relationships is what gives medicine its meaning. And so whatever we can to encourage that, to support that, I’m all for. One of the things that I started when I was a clerkship director at GW, I was the site clerkship director for all the students that went through the medicine clerkship at the Washington DC VA Medical Center, was a storytelling program where the students rotating through would capture the stories of the patients that they were caring for, actually listening and writing them down and then reading them back to the patients as a way of capturing that intensive listening and to really witness a patient’s story. Not their HPI, but that deeper story of maybe losing their independence or their identity through their illness and things they’re really struggling with.
One of the things that came out of that was just how powerful that was. Patients cried, they hugged their students. They said, “Can you be my primary care doctor because I’ve never been listened to that way before?” And those experiences were so, so meaningful. So it’s something that I’ve incorporated in my practice as well is really trying to listen to those stories and making sure our patients know about them too, because sometimes we know their stories and we’re not sharing them back, but how powerful it is for patients to know that we heard them and really understand where they’re coming from.
Toni Gallo:
That’s great, and I hope our listeners are thinking about how they can incorporate some of these ideas into their own teaching or their own clinical practice. I want to move on to one of the other quotes from Kathy’s essay and she writes, “Each time the attending placed her hand on my leg, before the sound that made my insides jump. If it were not for the caring steadying hand my leg, I may have involuntarily leapt off the table.” And I’m hoping you can all talk about this idea of comforting a patient with physical touch and just, in a really stressful time, what’s this looked like for you as a clinician and maybe what’s that meant for your relationship with your patients?
Katherine Chretien:
I’ll say that as a patient with that hand on my leg, I was surprised how much that brief touch meant to me. It was the comfort of another human who was looking out for me. And it wouldn’t have been so well expressed just by verbal like, “Oh, it’s coming.” But that hand, I just felt this sense of comfort and it was so powerful. And I think that our instinct as humans is to comfort through touch and sometimes we hold back on that, but I think in my practice, it’s sometimes looked like holding a hand, it’s been squeezing a hand, it’s been a handshake. Sometimes it’s been a hug for a family member who’s grieving the loss of someone.
And I do remember one of my attendings when I was in residency, we would round together at the bedside and he would always squeeze the big toe of the patient. Hopefully nothing was going on with the feet or lower extremities, but he would give a little gentle squeeze when we were leaving. And just thinking about what that might’ve been like for the patients to know that someone was thinking about them in that way.
Grant Wilson:
Kind of reminded of one experience where we had a patient that their respiratory status was kind of decompensating and so we’d called a lot of extra help to the room to get them to the appropriate level of care. And in that, I just kind of put my hand on their shoulder and explained to them the best way that I could, what was going on right then. And I think that physical touch is really just so important, that hand on the shoulder, it just helps a patient take a room that’s suddenly filling with lots of people and machines are alarming and all these things and they’re scared and I think it helps them lock in. And I was able to just look her right in the eyes and say, “Hey, this is what’s going on. We’re going to get you taken care of.” And I think that it was a stressful situation. I can’t take all the stress out of it of course, but I think having that hand on her shoulder helped kind of just calm her down and helped her kind of lock in on saying, “Okay, this is the thing that I need to focus on. This is what’s going on right now” amidst what would seem like chaos.
Michelle York:
Yeah, every time I hear stories like this, I’m so moved to hear that these are the things that really impact our patients. And it’s such a good reminder I think to physicians, clinicians, whatever your role in health care is that these things that we do matter, again, perhaps just as much if not sometimes more than explaining certain intricacies of what we’re doing or seeing.
And I think a kind of reminder of this similar to the story told in the essay is I had a patient who was quite ill and I was new to her team, but I’d come back a couple of times during my call shifts to kind of just sit with her, see how she was doing, talk with her and her family and then just enjoy their presence. And she is just the most lovely person you could imagine. And she one night was getting some exciting news and turned to me and just said, “You’ve meant so much to my care. You coming back and sitting here, giving me hugs and holding my hand has made me get through a lot of really challenging moments and you’ve impacted my care.” And I was sitting there reflecting, saying she’s been in the hospital for months, I really haven’t done that much. But I think that was the medicine side of me speaking, saying, “Well, I didn’t diagnose X or Y. I didn’t change too much as far as her medicines.” But the human part of her was telling me that I had contributed meaningfully to her care just by being a human with her and remembering to see her as such as well. So I think again, in our busy worlds, it’s really inspiring and invigorating to remember that these things are very tangible, that we can make differences with just a small touch. It doesn’t take a lot of extra time.
Toni Gallo:
Grant, before I think you mentioned patients feeling like you’re in their corner, there’s somebody who’s got their back, and you all have mentioned a few different examples or ways that you’ve shown patients that you care in this way. And I wonder if there are any other small things that you all do, a hand on the shoulder, sitting with a patient, anything like that that really helps you show them, “I’m here for you, I’m looking out for you. This is a big scary thing that’s happening, but there’s somebody who’s here for you.” If there’s anything else that you think about doing to show your patients that?
Katherine Chretien:
I think as Michelle mentioned, sometimes it has nothing to do with the medicine part and it’s about the caring part of another individual. And I was on service last time and I remember there was a patient whose clock in their room was wrong. It was off by an hour still, like daylight savings had been weeks before and no one was coming to change it. And I stood on a chair … Actually that was not favored by some of the people on the floor, but I stood on a chair to change that clock because someone deserves to know what time it is. And it’s like doing things like that, getting a blanket, looking out for someone in ways that show that we are listening to them and we care. There’s no task that is not ours to do when it comes to doing that.
Michelle York:
Yeah, I completely agree. I think one other thing that I would share that, again, another mentor of mine from before medical school gave me when I was shadowing, Dr. Deepak Gupta said, I was once told by a mentor to walk my patients to the checkout desk in clinic. Even if a day is busy, to just take that physical time and just the symbolic act of walking with them, walking next to them. Not only can you potentially gather additional clinical information about how they’re doing with walking, but additionally those extra moments I often find, as I’ve made that part of my practice, those extra moments often give us time to catch up on additional aspects to their life. My patients inevitably thank me for walking them to the front by closing out that visit and just taking that extra 30 seconds to be with them and be in their presence. And so it’s one thing I hope to continue to carry with me.
Grant Wilson:
I think one thing that’s been really impactful for me. As an intern, we’re often pre-rounding on patients and it’s a busy morning, you’ve got lots of patients to see, so you only have a few minutes. And I think something that’s helped me almost make that time last longer is just kind of crouching down next to the patient’s bed and getting eye level with them to hear, “Hey, how was last night? How are you feeling today? Anything that you want to make sure that I talk about on rounds today?” And I think it helps to just be more in tune with the patient to be at their eye level rather than person in a white coat standing up tall while they’re resting in their bed. I think it helps to form a connection with them and just let them know like, “Hey, you are my focus right now. How are you feeling? And what can I do to help?”
Toni Gallo:
Over the course of our conversation, you’ve all shared things that mentors have helped you with or that you’ve learned from colleagues or patients. But I wonder if there are any other kind of messages or lessons learned, pieces of advice that you want to share with listeners, thinking about the themes of Kathy’s essay and some of the other things we’ve talked about today. Is there anything else that you’d like to share with our listeners?
Michelle York:
I think one other thing, just to go back to highlighting just what an asset I think medical students and trainees are to patient care teams is one other thing we often talk about in medicine is that these are things that we do and see every day. But for a patient, in this essay describing a biopsy, that may be their first time going through that procedure, might be the first time thinking about this list of potential things that this mass could be or represent. And I think medical students, in part because they’re newer to the medicine model, so often are able to connect with patients on remembering how that must feel and remembering to make sure to acknowledge that newness and the emotions that may come with that.
And I just hope that more experienced clinicians can remember to learn from medical students in those moments, at acknowledging the importance of thinking about what the patient must be feeling, what questions they may be having, what anxieties they might be feeling. Even again, if it’s something that we see as completely benign, not anything to worry about, it may be still something that they’re worrying about and that’s important and valid. So I think medical students serve as just incredible advocates in that way.
Katherine Chretien:
I love that and totally agree. And also thinking about how everyone on that teaching team, everyone has a role and a way that they can add to patient care, that makes it a really rich experience. You have all these learners coming together and the attending and trying to make the best care happen. So I think that is one of the things that I take away from this experience as well as just all those little moments of what it can mean to patients, that touch, those words, those things that you do can really impact their experience, their stress, and really thinking about that as we go on through our days.
Grant Wilson:
Yeah. I guess the one final thing I would want to pass on is just listening to the patients. So often I can get into a pattern of wanting to ask this question and the next question and the next question, and of course that’s important in helping narrow down a differential or decide next steps. But I think I’ve been pleasantly surprised so many times when I don’t ask those questions, when I just listen a half second longer and the patient jumps into something and just tells me so much information that I probably wouldn’t have gotten with kind of the narrowed questioning. But they will tell you, and I think that allows the patient to be more of a participant in their care, it allows you to build more rapport. Instead of them just being subject to kind of rapid-fire questioning, they get to really share what’s important to them and you learn not only a lot of medical information from that, but really learn about the patient, what’s important to them, what makes them tick, and I think builds that connection, which I think is so critical.
Katherine Chretien:
I think in all of this, the common theme is being open to connection and how those connections can enrich the patients, but also us as their caretakers and as part of the treatment team. It’s that connection is what gives us all meaning in this experience and to remember that.
Toni Gallo:
I think that’s a great note to finish up on here. Does anybody have any other final thoughts they’d like to share?
Katherine Chretien:
I wanted to thank Michelle and Grant for being part of this because this has been such a wonderful conversation that has filled my soul with goodness from just listening to the two of you. And our listeners can’t see our video, but we’ve been nodding vigorously to whatever everyone says, and so I want to thank you for having this conversation and delivering such wonderful care to your patients.
Michelle York:
Thank you so much for having us and inviting us to be a part of this experience. I similarly am finding my cup filled after hearing these stories and being reminded of just the impact of humanism and medicine, both again, as was stated on our patients, but also on us and our energy in a very challenging career.
Grant Wilson:
Absolutely. I couldn’t agree more. Thanks so much for having us.
Toni Gallo:
Yeah. Thank you all for being here, and I want to encourage our listeners to check out the essay that we’ve been discussing today. The written version is available on academicmedicine.org or you can listen to Kathy reading it here on this podcast in our archives, so definitely go check that out. And thank you all again. I appreciate you being part of this conversation and it makes me feel good to know that you all are out there caring for patients.
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