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FORUM Getting in Touch with the Human Side of Illness Ellen Rothman As we walked out of my patient's room, the senior physician turned to me. "So, Ellen, what did you observe in that interaction between me and the parents?"     Knee pain had brought Connor to the rheumatologist, but we had felt confident that his were the routine aches and pains of childhood. The senior physician, however, had found subtle evidence of the skin condition psoriasis, a dry, flaky rash, which was most likely unrelated to the knee pain. While some patients with psoriasis also develop arthritis, Connor's pains in no way suggested arthritis. The parents seemed to have listened carefully to the physician's words as he reassured them.     "What do you mean?" I asked. "That seemed like a pretty reasonable interaction to me."     "That mother was nearly in tears," the senior physician said. "To her, arthritis means crippled. You have to be very careful of what you say to parents. Our words carry great meaning. I may have said too much, even though I tried to be reassuring. What did you see?" he asked the medical student.     "That mom did seem pretty stressed," she said. Sharpening the Clinical Eye As the physician turned away to see his next patient, I thought back over the interaction. I entered that room as a doctor, interviewing Connor and his family about his symptoms, performing a detailed exam. When I returned to the room with the senior physician and the medical student, I carefully watched the way the physician manipulated Connor's knee to find even minute abnormalities, and I studied the words and numbers he chose to explain the situation to the parents. I observed the parents' experience of this moment only out of the corner of my eye.     When I graduated from medical school, I yearned to feel like a doctor. Yet I feared the desensitization created by the stress and fatigue of residency. Still, I trusted myself to remain sensitive to the personal lives of my patients despite the time pressures. Now, all of a sudden, I realized that while I still felt I could be a caring doctor, I had become merely a clinician. My ears have dulled to the human story while my eyes have sharpened to search out physical abnormalities. As a medical student working with a busy hospice nurse rushing from home to home to see all her patients, I learned how little time is required to be caring. Now as a resident, I am learning how much effort it takes.     Recently, my co-intern lamented our frantic lifestyle: "As a medical student, I used to just chat with my patients. Now I still take time to talk to them every day, but it's usually in the context of finding out about their symptoms. I hope when my days are less about to-do lists and checking off boxes, I'll have time to be human again." Needs Beyond Illness A few weeks ago, as I sat at the work station well after midnight writing orders and finishing notes, I heard a child crying in a room down the hall.     "I want to stop crying, but I just can't!" he wailed as the nurse tried to comfort him. He was 4 and a half years old, and his mother had left for the night to care for her younger children. He had woken up in the middle of the night alone and had become frightened.     By the time I went to see him, he was quietly watching a video from his bed. I promised him a bedtime story in half an hour. I finished the last of my work and picked out Lyle, Lyle Crocodile, a childhood favorite of mine. But by the time I made it back to read the story, he was sleeping fitfully in the yellow glow of Jiminy Cricket.     Now at the end of my first year of residency, I have learned to take an efficient history, to tease out the clinical details, to order the right tests. I have learned how to get my paperwork done and still find time to eat dinner, to go to the bathroom, and to occasionally get a little bit of sleep. I have become a clinician. And still, I yearn to be a doctor. —Ellen Rothman, HMS '98, a first-year pediatric resident at Children's Hospital in Boston Back to Top