A night at the museum--helping residents "see" their patients.

Virtual Mentor American Medical Association Journal of Ethics August 2014, Volume 16, Number 8: 599-603. ETHICS CASE A Night at the Museum—Helping Residents “See” Their Patients Commentary by Johanna Shapiro, PhD, and Joel Shallit, MD Katherine is a third-year medical student on her internal medicine rotation at an academic medical center that serves as a busy tertiary-care hospital for its region. The residents she works with are swamped with work; when they are not actively admitting and caring for patients, they are inundated with paperwork, submitting online orders, and completing health record notes. Katherine knows that the residents are kind and generous people who have been selected twice—for medical school and then for residency—on the basis of test scores, academic performance, and character recommendations. She cannot help but note, however, their frustration with patients who demand so much of their time, their irritation with nurses who page them about questions the residents think have obvious answers, and their eagerness to “turf” patients to another service or practice center to lighten their case loads. She can understand the origins of these behaviors while feeling that the residents are in danger of burning out and becoming more cynical than would be healthy for a long- term career. One evening, Katherine’s entire team is asked to stop working at 4 p.m. and take a trip to the Museum of Fine Arts. The residency program director is an advocate for innovative approaches to encouraging self-reflection among the residents and helping them see patients as people rather than diagnoses. He has asked the internal medicine teams to take turns going to the museum to look at and frame discussion around artwork as a way of generating conversation about medicine, patients, and life as a trainee. Katherine hears the residents complain that this outing is intended to force-feed them empathy and humanism; they consider it a waste of time that could be better spent on patient care and leaving the hospital at a decent time. Commentary Medicine is both an art and a science. As the great William Osler noted, “The practice of medicine is an art, not a trade; a calling not a business; a calling in which your heart will be exercised equally with your head” [1]. Residency programs struggle to balance art and science with seemingly endless, often overwhelming hard work. It is no wonder then that, for stressed, burned-out residents, such as the ones Katherine observes, art and perhaps even science take a backseat to just getting the work done. In the hypothetical (but in our experience, very plausible) dilemma posed, we see three interrelated issues. First is the residents’ perception that a “field trip” to a museum is a waste of time, distracting them from their real work. The second is that the residents resent being “force-fed” empathy and compassion. The third issue is how to acknowledge and address the residents’ negativity and burnout. www.virtualmentor.org Virtual Mentor, August 2014—Vol 16 599