Truth Be Told | More than just statistics and symptoms

There is a certain arrogance that comes along with being healthy. This isn’t the conceit of one-upmanship that usually comes to mind, but the quiet, reassuring companion that allows you to read that “one in X” statistic about a disease unfazed. The arrogance gently convinces you that things like that only happen to other people … you know, people who aren’t healthy like you and me. But for those who have daily dealings with the sick, dissociating yourself from statistics can be dangerous.

That doesn’t mean that people need to embrace probability to the extreme. Car crashes kill a great number of people, but that doesn’t mean you have your last rites administered every time you strap yourself into the front seat. But it’s important for the medical community to remember that the whole of the patient is greater than the sum of his or her symptoms.

The traditional medical-school curriculum model is two years in the classroom studying the sciences — first normal body systems and then diseased ones. The last two years are spent on the wards, getting a more first-hand experience of what is to come after graduation. Transitioning from being a bookworm to being on the wards is no easy task. After two years of tunnel vision and retinas burned with PowerPoint slides, some of the initial ardor for patient interaction may become blunted with facts and figures.

Thankfully, like most things that are a century old, this model is gathering dust, and medical schools nationwide are taking out their feather dusters. A recent New York Times article points out a number changes at medical schools. For the first time, medical students at New York University School of Medicine are beginning a curriculum that increases the emphasis on earlier patient contact and building relationships between students and patients. Guest patients are invited to speak about their conditions and the disorders’ effects on their lives. Third-year medical students at Harvard University now see patients regularly to foster more personal relationships. Last year, Columbia University College of Physicians and Surgeons and Johns Hopkins University School of Medicine shortened their preclinical stint as well, and the latter also introduced a clerkship in which students follow patients for an extended period over their first and second years.

What I read in the Times sounded mighty familiar. Penn has been interweaving student-patient contact early on for a quarter century, said Anna Delaney, chief administrative officer of academic programs at the School of Medicine. Patient visits and early entry into the clinics started as part of an older version of the curriculum. And for the past eight years, in the Longitudinal Experience to Appreciate Patient Perspectives program, pairs of students are matched with patients with a chronic illness during the students’ first three years of medical school.

Penn’s program can be a way “to shape [students’] way of thinking before the realities of the floor: the cynicism, burnout and pressures,” said Horace DeLisser, a preceptor for the doctor-patient course, which espouses the importance of sensitivity and cultural competence. “There is disease, and there is illness. Illness occurs in a social context and it’s important to become comfortable with the individual patient,” he added.

Medical students at Penn see more illness in their first years than students at many of Penn’s counterparts, and I suspect we’ll be better for it. For example, the guest-patient portion of genetics class helps to put faces on illnesses so that students see more than just the diseases. Patients don’t talk only about their symptoms, but also their relationships and aspirations.

While it’s great that Penn’s ahead of the curve (though under the radar of the Times), look out for even more medical schools to make this shift in the future. This will bode well for the rest of us if we become one of the “one in X” statistics.

Mark Attiah is a first-year medical student from Dallas. His e-mail address is attiah@theDP.com. Truth Be Told appears on alternate Thursdays.

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