Maintaining Humanism Through the Process of Medical Training

Prior to medical school, there were times I considered becoming a chaplain instead of a physician. There was something I found incredibly rewarding and inspiring about helping people find hope and meaning in the face of imminent or uncertain death—particularly in resource-limited settings. Although I ultimately pursued medicine so that I could meet patients’ physical needs, I also hoped to practice in a way a chaplain would—caring for patients’ psychosocial and spiritual needs as well. With this in mind, I began third year with almost a ministerial-like zeal to holistically care for my patients’ needs. “I finally get to actually participate in the care of patients,” I thought to myself. Third year was going to be the pinnacle of all of my years of preparation.

Dozens of evaluation forms later (in addition to hundreds of USMLE practice questions), I found

that my passion for my patients began to wane. Somewhere in the middle of my third-year clerkships, I realized I was operating out of a desire for the approval and recognition by attendings and upper-level residents. “Honors” was the badge I coveted.

There was no specific moment I could point to; instead, it was the accumulation of minor critiques, feedback, praise, and conversation with peers. It was subtle comments like, “If you want to go

to x residency, you need y (i.e. Honors, good evaluation forms, a better USMLE score, AOA, Gold

Humanism Honors Society, etc.).” What exactly went wrong? More importantly, how could I become

more human again and strive to care for patients holistically?

Social theorists have argued for some time that the process of medical education inherently trains

students to distance themselves from the social realities of patients. In his Fresh Fruit and Broken Bodies, physician-anthropologist Seth Holmes argues that contemporary clinicians are trained in the clinical gaze, “one in which physicians are increasingly taught to focus on the isolated, diseased organs, treating the patient as a body or series of anatomical objects.”

Debrework Zewide reminded graduates of the Icahn School of Medicine commencement speech

in 2018: “The poor and sick are human and not only deserve your empathy; they deserve your respect.” Yet in our world of medical training, respectfully caring for patients—particularly those who are poor and sick—is often less important than being competent and successful physicians, despite our best intentions. Without respect for our patients, they become a means to an end, not individuals with inherent dignity.

In medical school, the drive to become competent and successful physicians can hinder us from

treating the poor and sick with dignity and respect. For instance, we are shaped by visions of success propagated on online forums and residency websites in ways that shift our focus away from our patients. Through the process of test preparation and resume-building, many of us have begun to see the purpose of medical education as self-improvement, a step in the direction of a satisfying and high-status career. This kind of mindset shields us from having to think about realities of pain and suffering that we see in our patients. The irony is that while our decision to study medicine is based in the desire to help others, our career-driven medical education focuses on us. Narratives of success are embedded in our systems, language, and culture at large.

So what do we do? How do we lead lives of solidarity with our patients, particularly those who

come from resource-limited settings and poverty? I believe we must cultivate routines that re-orient our lives with human dignity and compassion at the forefront. In recent months, I have attempted to cultivate routines that involve prayer, reading a book, church, exercise, volunteering at community workdays at KKV’s Hooulu ‘Aina, and cooking for and eating meals with my grandparents. These activities have reminded me that I am a part of family and communities larger than myself—the same kinds of social networks that the patients I care for come from.

Respect for patients—particularly the poor and sick—is central to humanism and compassionate

care. Many of our patients live within complex and difficult social circumstances, and they deserve our utmost respect. However, because our system preys on fears of failure and insignificance, it is easy to lose sight of the world of our patients’ reality. I believe a commitment to compassionate care for our patients requires steadfastness and a commitment to solidarity.