The hierarchy in medicine is impossible to ignore. Medical students shuffle, interns survive, senior residents manage, and staff attendings command. Fortunately, these relationships have evolved over the last few decades and past feelings of authoritarianism have turned into mentorship. When I read Malgorzata Nowaczyk’s personal essay "Your Father’s Heart" (Intima Spring 2016), I felt her suffocation as a student and am grateful that I haven’t experienced something similar.
In my piece "Bad Lungs" (Intima Fall 2017), the younger female doctor comforts the patient, without being prompted or stopped by the staff attending. The stiffness in Your Father’s Heart would not have allowed for that kind of behavior, as the medical student’s role was more subservient than patient-centered.
As the focus of medicine turns away from the hierarchy towards patient-centered care, hospital environments become more conducive for learning. Medical students are more comfortable asking questions and residents are more comfortable asking for help. A student and resident’s quality of life has become more important, recognizing that rested and balanced personal lives promote healthier work environments and produce better doctors.
With this shift in medical culture, patients are allowed to be part of their own healthcare, as participants rather than subjects. In "Bad Lungs", the staff attending takes the time to show CT images and explain the disease process to the patient, which allows the patient to ultimately conclude that she has a choice in her health. In contrast, the patient in Your Father’s Heart doesn’t have a choice in what happens to him and is finally able to reveal his wishes only after his brother arrives, mainly due to a language barrier.
The medical community is likely to see even more changes as specialties like Palliative Care develop, allowing patients more decision-making power. This will inevitably improve relationships between provider and patient as well as among providers themselves.
Kany Aziz is a third-year Internal Medicine and Pediatric resident at West Virginia University. She is originally from Florida where she completed medical school at Florida State University. Aziz hopes to work for an international health organization and complete a Palliative Care Fellowship.
© 2017 Intima: A Journal of Narrative Medicine