Dana Vigue
Harvard Medical School
ABSTRACT
Medical students serve many unique roles in a patient care team. Of great value is the amount of time medical students can spend by the bedside forming meaningful, longitudinal relationships with patients and their loved ones. In the midst of the COVID-19 pandemic, many medical students have transitioned into virtual patient care roles. This article explores how sitting by the bedside can be reimagined in this era of physical distancing.
“Medical students are in the unique position to spend much more time with their patients than other members of the team can. Never take for granted how much care you can provide by being by the bedside, learning about your patients’ lives outside of the hospital, and spending time with their loved ones.”
My senior resident relayed this advice as she led me through the maze of corridors I would call home during my Medicine rotation. I would immediately forget how to navigate those corridors, but I would not forget her words.
Before my clinical year of medical school, I had only abstract ideas about how such quality time could shape clinical care. I imagined that this link would be indirect; at my skill level, I did not expect that I could meaningfully contribute to anything other than morale. Nevertheless, I appreciated that morale is a critical component of recovery, and I prioritized my relationships with patients. I eventually found myself positioned as an informed patient advocate capable of shaping the care a patient would receive.
In one instance, my daily, hour-long conversations with a patient and her spouse led to my understanding of her life-long experiences with environmental racism which made her wary of undergoing tests that involved exposure to ionizing radiation. I was able to dispel persistent misunderstandings regarding her care preferences and collaborate with members of my team to provide creative, high-quality alternatives for her diagnostic work-up and subsequent treatment.
Like many of my classmates, I have immensely valued my unique role in a care team. As future physicians, we find fulfillment in our ability to alleviate suffering, and we have learned from our mentors that this involves both biomedical and humanistic care.
As the current COVID-19 pandemic began to escalate in the United States, medical students were transitioned out of direct patient care roles. During the first week of virtual medical education, many of us felt a sense of urgency without a clear outlet for action. Thanks to the collaborative efforts of medical students and our dedicated mentors, the infrastructure for critical new health care interventions was built from the ground-up in record time. Many of us quickly transitioned into virtual patient care and advocacy roles, expanding the capacity of our critically strained care delivery systems.
As SARS-CoV-2 rapidly sweeps across the globe, we have rushed to keep up with the spread, stay ahead of transmission, and flatten the curve. As we conduct telehealth visits for patients with COVID-19, call patients with food scarcity to connect them with local meal resources, follow up with postpartum OB/GYN patients, and engage in many other crucial patient advocacy activities, let us not forget that we still occupy a unique role in patient care. Now, more than ever, some of us may still find ourselves able to spend longer with our patients than other members of our team. As I find myself in that privileged position, I am reminded of my resident’s words of advice.
In partnership with the Crimson Care Collaborative at Harvard Medical School, I am currently conducting longitudinal telehealth visits with patients diagnosed with COVID-19. After assessing my patients’ clinical trajectories and attending to their medical concerns, I take the time to ask how they are coping with isolation, how their loved ones are doing, and if there are any resources that they need. In these hurried times, this is a rare moment when time seems to stand still. Patients have expressed feelings of loneliness, fear, and confusion. One patient shared how emotionally painful it has been to isolate from his wife and young daughter for weeks on end. Another patient lacked the resources to isolate from other members of her household and divulged feelings of intense guilt after five of her children had become symptomatic since her diagnosis. In some cases, I am able to collaborate with social workers to connect patients to social supports in their communities. In other cases, I can normalize a patient’s experiences with difficult circumstances and the emotions they bring up. Other times, it is simply my role to bear witness to these challenging experiences during such unprecedented times.
As medical students’ roles shift alongside the rapidly changing landscape of medical care, let us not forget to retain the unique aspects of our roles as caregivers. Although we may no longer be physically present by the bedside, we can find new ways to sit with our patients. I firmly believe that patient care of the highest quality is not possible without meaningful investment in patient-provider relationships. Let us continue to pursue our understanding of each patient as a whole person and initiate critical interventions informed by the context of a patient’s life. It is a radical act of caregiving to halt the breakneck pace of our work and affirm the lived experiences of those who trust us with their health. As the necessity of physical distancing has reduced patients’ access to family support and therapeutic touch, let us also not underestimate the healing potential of medical students’ extended presence and solidarity. In this way, we will carve out our roles as future physicians during this new age of physical distancing.