Patient Stories, Long-Term Relationships at Hudson Headwaters Health Network

Four third-year students at the Larner College of Medicine are completing the Longitudinal Integrated Clerkship at Hudson Headwaters Health Network. With primary care physicians as preceptors, and a primary care health center as a home base, each student becomes a key member of an interdisciplinary team providing comprehensive care to patients. Students progressively develop a panel of patients to satisfy all required clinical encounters for the clerkship level. They get to know their patients well over the course of the 12 month-long experience. Here, two students reflect on their time at HHHN:

uvmmedicine blogger Collin York '20
uvmmedicine blogger Collin York ’20

Collin York ‘20
Following a longitudinal patient through surgery is one of the more rewarding experiences in a longitudinal integrated clerkship. Despite the medical team’s best efforts at providing compassionate and individualized care, surgery can be stressful and overwhelming for patients. As students, we often have the privilege of time – we can afford to really sit with our patients and get to know them more as people. When our schedules allow us to do so, we have the opportunity to meet patients early in the year, follow them to their pre-op visits, scrub in and assist in their surgeries, and check up on them through their recovery. Patients are thrilled to see a familiar face every step of the way.

In addition to doing our patients a service by contributing to continuity of care, our learning also benefits because we get to see the patient’s pathophysiology from workup, to surgical treatment, and through follow-up. Even though we use advanced imaging techniques that allow us to visualize people’s organs, there is really no substitute for directly viewing and holding someone’s gallbladder – the very gallbladder that had been causing the patient’s biliary colic we had evaluated in the outpatient office. During surgery, I experienced many “aha” moments that made much of my preceding book learning “click.”

uvmmedicine blogger Izzy Kratzer '20
uvmmedicine blogger Izzy Kratzer ’20

 Izzy Kratzer ‘20
Since my introduction to the anatomy lab in the first year of medical school, I had adopted something of a ‘suppress and obsess’ mentality for the portions of medical education that made me truly, viscerally uncomfortable.  Don’t have the emotional energy today to really wrestle with that lab dissection?  No problem.  Leave those feelings at the door, grab a stool and some scissors, and make those vessels look perfect.  Don’t look at anything else.  Don’t think about anything else.  Just fixate.  You can deal with your emotional response later.

It turns out, this little routine maps well onto the operating room, with its ritual sterility, drapes, and detachment.  There, machine-like precision somehow makes sense.  Even for those of us who don’t mind the sight of blood – who can’t wait to get our hands on whichever organ has just been pulled from the abdomen – thinking about the real person under all the blue paper makes your heart quicken.  So, for my first six months in the LIC, I found my obsessive focus in the OR.  The inside of the abdomen became a distinct world, confined to that laparoscopic video screen, where I could follow the surgeons’ instruments and test my navigational skills.

Through the LIC, I had the chance to follow some of my patients through consults, imaging tests, follow-up appointments, and into the OR. Before, I had chosen to let all of our patients exist as a brief blur of an interaction, at least until the procedure had ended. I wanted to know their stories, how their discomfort or disease fit into their everyday lives, but I’d chosen to push those things from my mind in the OR. With the patients I came to know through the LIC, I decided it was time to let their story into the room with me.  When things went well or became unexpectedly difficult, I forced myself to think about the person I’d followed over the last six months, the fully fleshed out individual whose life and family I had come to know. The long journey I went on with these patients became the experience of the OR as I hoped I would someday see it: a place where the whole patient, whose disease is only a brief chapter of a larger narrative, could come together with hands-on interventions meant to improve people’s lives.




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