Medical students spend the first half of their education learning anatomy and physiology, and the second half applying that knowledge in the hospital. But where in that process do they learn the very important skill of listening and talking to their patients? In the panel discussion that followed yesterday’s announcement of The Bucksbaum Institute for Clinical Excellence, it was clear that even physicians who graduated from medical school decades ago remember exactly when and from whom they learned those important lessons. In some cases, that mentor was sitting just a few feet away, such as when Mark Siegler spoke of his time as a medical student learning from the now 102-year-old Joseph Kirsner.
“The way you learn medicine is by seeing, not by talking. You have to show what good care is about. I learned from studying people like Joe,” Siegler said. “Joe told us that everything was important, [including] science and clinical inquiry, but patients came first, patients were the absolute first priority.”
The Bucksbaum Institute, made possible by a $42 million pledge from The Matthew and Carolyn Bucksbaum Family Foundation, has borrowed that sentiment as its defining principle. Teaching bedside manner may not be as straightforward as teaching biology, but creating a system of mentorship can help experienced physicians pass lessons down to young and aspiring doctors. Perhaps with serendipity, the panel represented that kind of mentorship family tree, with Dr. Siegler seated next to his former trainee Holly Humprey, dean for medical education, and Dr. Humphrey adjacent to current Pritzker 4th-year medical student Rebecca Levine.
Each panelist and speaker at the event talked about the doctor-patient relationship as a phenomenon under threat in the modern health care system. Though better tests, treatments, and procedures have saved and extended countless lives, an increased reliance upon technology can interfere with the “old-fashioned” methods of taking a good patient history and answering patients’ questions.
“We were always taught that 90 percent of the diagnosis in medicine was based on what the patient tells you,” said Kenneth Polonsky, dean of the Division of the Biological Sciences and the Pritzker School of Medicine. “There are tendencies on the part of physicians to rely more on technologies than on what the patients tell them, their interactions with patients, and what they learn at the bedside.”
It makes sense then to start with doctors-in-training, and the foundation of the Bucksbaum Institute is the financial support of three to five new medical students a year as Bucksbaum Student Scholars [read more on the Insitute’s organization in the FAQ]. Because of the Pritzker School of Medicine‘s reputation as a “teacher of teachers,” (30 percent of Pritzker graduates go on to faculty positions at academic medical centers, Humphrey said), the hope is that the emphasis on doctor-patient communication seeded at the University of Chicago will spread around the country.
“This gift allows our medical school to make a very public statement to our students at the time they are applying to medical school and then during their experience in medical school, that the doctor-patient relationship is fundamentally important in the education of a physician,” Humphrey said. “Then, upon graduation, our students populate schools across the country and carry on that Bucksbaum tradition wherever they go.”
Between the medical students and the senior faculty deemed Bucksbaum Master Clinicians will be up to four young physicians named Bucksbaum Faculty Fellows. Physicians in this group will do the much-needed work of measuring the clinical impact of doctor-patient relationships and finding ways to improve the practice, through the rigorous process of scientific inquiry. Siegler said that there is a great need for more data on just how much a patient’s health can be improved through effective communication with their physician.
“One of the goals is the institute is to do the kind of translational research and outcomes research that we need to demonstrate the importance and effectiveness of good doctor-patient relationships,” Siegler said. “There’s a human encounter to deliver the scientific advance, and I think all of that is amenable to study.”
But as donor Kay Bucksbaum said in her opening remarks, there’s a “mutual satisfaction” that benefits both doctor and patient in a healthy relationship. Levine said that a renewed emphasis on the communication between physicians and their patients can help stave off burnout and keep students focused on their original altruistic reasons for choosing a career in medicine. A full “toolkit” of patient interaction – knowing when to provide compassion or education or, in some cases, poetry – can help both the sick and the healer feel better, she said.
“I think this should be for all doctors,” Levine said. “In this increasingly technological world, we have many diagnostic and therapeutic tools that are very advanced. But that doesn’t mean we can lose sight of the most important aspect in medicine, which is our patients – remembering the humanism behind medicine and taking really high quality of them.”