Krista Edelman, M’11
A patient doesn’t fill his prescriptions. Another doesn’t exercise, worsening chronic conditions. Still another is always late to appointments.
It’s frustrating for physicians, and easy to assume these patients just don’t care. But there are other sides to these stories, and an innovative program is helping interns find them.
“When there’s a disconnect between providers and patients, we sometimes don’t realize the issues that are affecting patients so they cannot adhere to a treatment plan,” said Bennett Lee, M’94, ambulatory clerkship director and associate professor in the Department of Internal Medicine. “We were thinking about how to really engage the interns with their patients and make sure they understand what a privilege it is to take care of them.”
Chief Resident Krista Edelman, M’11, along with Lee and Stephanie Call, M.D., M.S.P.H., associate chair for education in the Department of Internal Medicine, developed a cultural competency program, a four-week rotation designed to help the department’s interns:
- Discover social and physical environments affecting health.
- Reflect on how a better understanding of health is affected by the conditions in which patients are born, live, work and age.
- Communicate and share these experiences.
The program began in 2014, and about 30 interns have completed it so far. “The experience has been eye-opening,” said Edelman.
The interns are encouraged to go beyond standard medical examination questions to try to understand patients’ lives. They ask about family dynamics, income and whether or not they have convenient ways to obtain healthy food and necessary medicines.
They then go out into the community, sometimes using public transportation, and explore the neighborhoods where their patients live. Edelman prompts them to look around and see:
- Are there signs of disrepair (broken windows, graffiti, overgrown grass)?
- Are there parks or recreational areas in the neighborhood?
- What supermarkets are available and do they carry affordable fresh produce, meat and other healthy food?
- Are there functioning street lights or a sidewalk?
- Where is the closest bus stop?
What they’re finding is changing the way they practice medicine and view patients, said Edelman. “They’ve taken photos of the food available, which might be something like a packet of bologna and potato chips, maybe an onion. It’s a revelation for these physicians, who wonder why patients aren’t eating more fruits and vegetables.
“Seeing the neighborhoods where the patients live, they come back and say, ‘I don’t think I would feel comfortable walking there alone either, let alone a 60-year old female patient.”
Interns might discover that a patient has to travel several miles in a wheelchair to get a prescription filled, or is too frightened to go out or maybe has to depend on three city buses to get to a physician’s appointment.
“In medical school, people are so keyed in to the science of how to take care of folks that sometimes they lose track of the idea that this is a person,” said Lee. “You need to ask, ‘how do I communicate with them? How do I understand?’”
Watch a digital story
by Christina “Nina” Vitto, M.D., resident in the Emergency Medicine-Internal Medicine combined residency program
The culmination of the cultural competency program is creating a reflection piece on the experience, usually a digital video on a subject or patient who affected interns deeply.
Edelman believes this reflection will make them better, more compassionate physicians. She’s also heartened by recent updates to the MCAT exam that tests prospective medical students. In 2015, the exam was expanded to include a section on behavioral and socio-cultural factors.
“My parents are social workers, and I’ve always had a passion for the service in medicine,” she said. “It’s easy to get so jaded when you’re working long hours and patients come in who are obviously neglecting their health.
“But that’s not acceptable for physicians. I want to bring back the humanism.”
By Lisa Crutchfield