Letter to New Medical Students (4)

In your Clinical Medicine class you will be able to talk to real patients starting next week.  They will know you are first year students and will not expect you to be physicians.  You will learn that you can take a good medical history from a patient even if you have no clue what to do with the information.  This experience highlights the importance of the human qualities you bring to the bedside because you won’t have any medical qualifications at that time.

Part of the Clinical Medicine class will include writing one-page essays about your patients from their perspective.  These exercises in Narrative Medicine (1) are then shared with small groups of classmates to develop your empathy skills.  You will also be taught how to take a Stress History (2) because studies show that a majority of patients’ symptoms can be traced to psychosocial stresses in their lives.  We want to avoid what Alan Barbour, MD (3) described as “a truly appalling practice of splitting our patients into minds and bodies, relegating the former to the “shrinks,” the latter to “real” doctors – a schizophrenia of care.”  As he goes on to point out: “After a negative coronary arteriogram, the cardiologist, for example, diagnoses “non-ischemic chest pain” but does not seek to determine if the pain could be emotionally induced, or, if so, to understand the human situation well enough to find out, possibly, what really does cause the pain.  Nor does anyone else.  Yet that is what the patient needs most of all.”  (3, p 17) Our graduates will not have this blind spot. (more in the next post).

(1) Charon, R. Narrative Medicine. (2006)  Oxford University Press.

(2) Clarke, D.  They Can’t Find Anything Wrong. (1997).  Sentient Publications.

(3) Barbour, A.  Caring for Patients.  (1995). Stanford University Press.

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