Partnering: how we teach, and how we give the best care

It’s summer time. For those of us who work in teaching hospitals, this has a whole extra meaning. It’s not just about hot days and beaches and summer vacations.

The new residents have arrived.

They are fresh from medical school, excited and a little scared. Here at Boston Children’s, the residents are an impressive group. They are all exceedingly bright, with lists of accomplishments that make me deeply grateful that Children’s accepted me all those years ago. They have learned a lot about medicine. What we teach them is about being a doctor.

This isn’t something you can teach by sitting people down and talking to them, or by on-the-job training. We teach them about being doctors by partnering with them in care.

In primary care, where I teach residents, the resident goes in and asks the questions and does the physical exam, and then comes and tells me what they’ve heard and seen. We discuss the patient, I go and do some questioning and examining too, and then together we come up with the best plan. The child gets cared for by both of us. Over time, the idea is that the resident does more and I do less. But they are never alone in caring for the patient—and that’s true throughout the hospital.

I like that we start new doctors off this way. Not just because this supports them in their new role, but also because really, in medicine, partnering never stops. Partnering isn’t just about teaching. Good health care is impossible without partnerships.

There isn’t a single doctor out there who knows everything there is to know about medicine and health. It’s way too big to know, and new information comes almost every day. Besides, fully caring for people requires skills that no one person could possibly have. We always turn to each other for help. We turn to specialists, to our colleagues, to nurses, psychologists, physical therapists, social workers, respiratory therapists, nutritionists, interpreters—there are so many people that can play a role in getting and keeping a child well.

Even the simplest health problem can be complicated—because people are complicated. Their environment, their supports, their resources, their emotions, their beliefs, their heredity…this is why we say that medicine is an art. Every single patient, every single family, is different and needs something different from us.

Which is why our most important partners are the patient and family. That sounds obvious, even trite, but it’s not always as obvious or easy as it seems. It can feel strange as the doctor, the one who is supposed to know everything and be in charge, to make joint decisions with a family. It can even more strange to let them be in charge, although sometimes that really is best.

One of the most important lectures in my first year of medical school was one I had in Histology class. The lecture had absolutely nothing to do with the microscopic anatomy of cells and tissues. The lecture Professor Goodenough gave us that day was about power. You are going to have a lot of power as doctors, he told us. The best thing you can do is to share that power with your patients.

“Being the hero or genius is great, but making the patient truly well is even better.”

It was inspirational, and I’ve never forgotten the moment, but it took me years to really understand what he was saying. It’s not just about being nice, you see. It’s about being effective. And over the years I’ve come to understand that power is best shared not just with patients but with everyone who helps care for a patient. We do things so much better that way. Being the hero or genius is great, but making the patient truly well is even better.

So every July, it starts all over again and the new, slightly scared faces appear and we have the opportunity to teach not just pediatrics but partnership. As we talk and examine and bring in others to help, we not only take care of patients—but show that the way to do it is together.

  • Amanda Davis

    I recently had a residential doctor as my Primary Care Doctor. She is the most caring Dr. I have ever had. She is well informed, spends a lot of time and really listens to what I have to say, which is rare. I have a few medical problems, but she is right on top of everything, always ready to face the challenge and that gives me the confidence and courage I need to keep going.
    I never met the attending doctor over her but I know who he was because i seen him in the office. She finish her residency in June and went to work at another local hospital working with inpatients only so I could’t follow her there. I miss her, and I do not like having to find another PCP..but I hope to find some one like her.

  • Wit

    The best doctors I ever had was the team of Residents at Beth Israel who took care of me during delivery of my first child. The were so capable and motivated, they really helped to make it one of the best experiences of my life! The new Residents are the best being trained by the best, they are lucky to be here, and we are lucky to have them.

  • Patricia

    I think that as a doctor the most important person to talk to and to inform is the patient themselves.  Regardless of the age.  Sometimes when you partner with the family members you may actually do more harm to the child or person.  You do not know what kind of relationship the child may have had with their relatives or if the information that you are given by a parent could be totally true.  If your information is not totally correct than your diagnosis of the situation is going to be completely wrong and your expected cure may never occur.  By being honest with the patient you earn their trust.  By getting their trust you already have won half the battle.  An individual knows what is bothering them or what is hurting them and knows how to recongnize the symptoms of new changes in their health.  Knowing that you are listening to what they are telling you and take what they tell you seriously could help you establish a good doctor patiant relationship.  The above is not learned in any book or school it is called common sense, good work ethics and doing what is right.  The only doctors that I have had that were great doctors were those that were not arrogant about their position and actually listened to what I had to say.