Blog | Thursday, January 8, 2015

After 35 years, patients teach the most


“He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.”
—Sir William Osler

We who pride ourselves on our medical education skills must remain humble. Our skills may be important, but they pale next to our patients. After 35 years of ward attending, our patients continue to teach me more about medicine. One need only observe third year medical students the first week of the year and then again 1 year later during their acting internship to see how much patients have taught them.

Our teaching skills work best when they relate to a patient. That explains why most learners endorse rounds and morning report as their most important learning times.

Each patient teaches us more. Sometimes they show us classic presentations of common disease; sometimes they show us classic presentations of uncommon disease; and sometimes they show us atypical presentations of disease. Each encounter, each patient, each response to therapy teach us a bit more about medicine.

This phenomenon clearly applies to all specialties. Patients are not widgets. Their histories for a disease vary widely. Many have classic presentations, but all too many present in atypical ways. Until we experience enough typical and atypical, we run the risk of missing too many diagnoses.

I tell the students every year to study their patients. As Osler says, read about your patients. When you learn from your patients, the lessons are much more likely to stick.

For those who give lectures, plan your lectures around case presentations. The audience will pay attention and are more likely to remember the teaching points if a patient presentation highlights the point.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.