Patience with Patients

The presiding doctor scrawled medical terms all over the white board, the sticky red of the marker matching his crimson Harvard sweater vest.
 
"A thirty-two year old male with sporadic ‘spells' of aggressiveness and an otherwise normal neurological examination.  Without an EEG, you are very much blindsided, but you can at least make guesses as to what areas are of concern here.  You have to localize, localize, localize.  Well?"

Like thoroughbreds out of the gate, my colleagues and I called out brain structures.
"Amygdala." 
"Hippocampus." 
"PFC."

"Good.  Neurochemical signatures?" the doctor prompted.

"Serotonin." 
"Cortisol." 
"GABA."   Easy.

On the opposite side of the classroom, the seven German students collaborating with us on the medical case twirled their pens and slumped in their seats, speaking in the universal language of disinterest.  Finally, one of them stood up. 

"Perhaps we can do it the German way now?  Use the clinical to inform the science?  Think of the person behind the proteins?"

This would not be the first culture clash informing our week-long stay in Witten, Germany.  At the Universität Witten/Herdecke, one of Germany's leading medical schools, students are trained from day one to consider, respect, and interact with the patient.  Their classes--anatomy, physiology, immunology, etc.--all converge upon a weekly case discussed on Wednesdays in a team-based "patient-oriented learning" setting.  Fridays are devoted to hospital work, when students can observe, question, and learn from a doctor's examination of a patient.  Academic success depends on not only clinical competence, but also consideration of a patient's financial and emotional situation.

Harvard College, on the other hand, spends four years training would-be doctors to think analytically and challenge assumptions.  Focus is placed on neither the patient nor the clinic, but the science behind it all.  Most students research in labs and entire courses are dedicated to reading, debating, and dissecting published papers.

So which system is more applicable to the modern patient?  While no study explicitly evaluates patient satisfaction in Germany against that in the U.S., research measuring the satisfaction of patients via an international assessment survey indicates that Germany has the highest ratings in patient care compared to those of other European nations.  With direct patient-to-practitioner contact, low wait times, and quick, flexible services, Germany outstrips Denmark by far and pulls alongside Switzerland's venerable health statistics.¹ This, coupled with the U.S.'s abysmal ranking in the WHO's assessment of the world's health systems,² seems to suggest that "patient-oriented learning" contributes to the success of patient care.

This is not to say the U.S.'s particular brand of medical training is completely flawed, nor is it to imply that the teaching methods of two universities are representative of entire nations' experiences of science learning.  However, leading institutions such as Harvard should consider introducing the patient at a "pre-medical" stage, if only to prevent our students from becoming analytical automatons too scientific to deal with the actual ailing person in front of them.  Until then, however, patients in the U.S. may very well have to wait before expecting better patient-directed care from their doctors.

 -- Tara Tai

¹ Wensing, Michel, Peter Vedsted, Janko Kersnik, Wim Peersman, Anja Klingenberg, Hilary Hearnshaw, Per Hjortdahl, Dominique Paulus, Beat Kunzi, Juan Mendive, and Richard Grol. "Patient satisfaction with availability of general practice: an international comparison." International Journal for Quality in Health Care 14.2 (2002): 111-18. Print.
² WHO | "World Health Organization Assesses the World's Health Systems." World Health Report 21 June 2000. Web. <http://www.who.int/whr/2000/media_centre/press_release/en/index.html>.
 

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