Bearing Witness to the Patient Experience

Flora Liu ’21

Written by Flora Liu ‘21

During 2019, I was a student in the Larner College of Medicine’s Longitudinal Integrated Clerkship at Central Vermont Medical Center. This gave me the opportunity to follow multiple patients through their illnesses and their journeys, getting to know them over the course of time. Some patients recovered quickly; others had multiple complications and took many months before they felt better. One patient in particular I will always remember, as following his journey was one of the most meaningful experiences during my third year of medical school. He showed me how important it is to bear witness to the full range of a person’s experiences, even as you work to diagnose and treat their medical conditions.

I crossed paths with this patient and his wife early in my clerkship.* While reading his chart, I found that he had several serious conditions affecting his lungs and gastrointestinal system. The first time I met him and his wife, they really didn’t know what his health conditions were and what he needed. They were so confused as to why they were in the office. He required his wife to answer everything for him, but his wife didn’t know what help we could provide. We used our best judgment to prescribe some medications and instructed him to follow up in four weeks. 

A month or two after our first visit, he returned and needed to be hospitalized for several cardiac issues. Upon discharge, he was instructed to have multiple follow-up appointments with primary care, oncology, cardiology, and neurology. During the period of follow ups, he had many diagnostic tests done on top of multiple medication adjustments. He was also given the diagnosis of Alzheimer’s dementia. 

During the time he was seeing different specialists, I attended multiple appointments with him and saw how his life had been impacted by all of the different medical decisions. I had the luxury to sit in the waiting room with him and his wife, getting to know their background and who they are outside of medical appointments. I learned how they loved to garden, read, and hunt, and I began to understand how these medical conditions were impacting their lives. I could witness their reactions after a new diagnosis, a discussion about a treatment plan, or changes to medications. I remember so clearly after the cardiologist spent 30 minutes talking about different treatment options for atrial fibrillation, the cardiologist paused and asked if they had any questions. The patient turned and said, “What’s a fib?”  Being so medicalized, patients are sometimes left confused, frustrated, and unsure where to ask for more help.

As medical providers, we are often focused on a patient’s problem list and our assessment and plan. Although this is an essential part of our training, we sometimes forget about who is sitting in front of us, what their emotional reactions are, and how their lives are being impacted. As a student with the luxury of time, I got to hear their complaints, frustrations, worries, and disappointments. This experience makes me wonder when we take the oath of “do no harm,” what are we doing to patients when we are only so focused on how we treat their problem list?

My time with this patient and his wife has given me the opportunity to approach my work as a physician from a different perspective. After many months of battling with his health conditions, and more than a year of constant medical visits and adjustments to treatment plans, he finally said he felt better for the first time. He may not be the perfect answer in a test question, and his medical regimen may not be optimized, but his quality of life has improved. After following him for the past year, I saw him go through so many ups and downs. I am so thankful that they welcomed me on their journey. At my last visit with him, I was just so touched seeing him feeling better. They were proud that they could provide me this educational experience. Reflecting on my time with them, I consider this one of the most rewarding experiences of my medical education. 

*Some details have been changed to protect patient confidentiality

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