I am sitting in a global health lecture while a woman who recently immigrated speaks about her experience navigating our healthcare system. She describes her struggles with the language barrier, highlighting how impossible it can be to get even over the counter medicine in somewhere so foreign. These patient-facilitated lectures always get to me, and I can feel myself getting a little emotionally carried away. It is during moments like these that I begin to understand what a gift patients can be and I start to ruminate on the resiliency of the human spirit. I am brought back down to earth by her next anecdote. She describes how difficult it was to retell her story to many different residents and clerks at a local practice, and how she had yearned for a consistent face that would care for her. Immediately, she adds that she recognizes the importance of learning, and expresses her gratitude for the care she received. But those words resonated around in my mind, for they were confirming something I have felt since my first patient encounter. By learning, I am taking. Taking awkward histories, taking time, taking away. And in the end, it is patients I am taking from.
I now refer to the heavy, sinking feeling that occurs after one of these encounters as my learner’s guilt. It sets in at the moment between when the physician asks the patient if I can observe and when they invariably say yes. Because at that point, we are already in the room, and they have been waiting- who would say no? I feel a pang of it in my chest when the patient answers a particularly intimate question and their eyes dart towards me, the intruder, before answering. And it thrums loudly in my ears when I attempt to do any physical exam maneuver and take double the amount of time their doctor would. I’m sorry, could I do that again? Would you mind lowering your gown one more time? Thank you, I’m sorry, thank you.
Learner’s guilt can feel overwhelming because it is inevitable. I will never be able to provide care as skilled as a patient’s physician at this stage in my career- I need to, well, learn. But I have to make some mistakes to learn. I have to go back and take a more thorough history because I forgot to ask the patient’s age. I have to listen to that murmur one more time because I haven’t heard one before. I have to stumble through sensitive questions to learn to never ask them that way again. While this is understandable and expected, it is also the patient’s who bear the burden of these first mistakes.
They also bear the burden of being studied. To be whittled down to your biology by your caregivers is not comfortable, and it can feel incredibly alienating. However, as a learner, this is also somewhat inescapable. To learn effectively, I need to see actual sick people, and talk about their actual problems in front of them with an actual physician. Yes, these patients have volunteered and given consent to be examined by a learner. But there are threads of guilt woven into any questions I ask about a patient that aren’t directed towards that patient. It can feel like a tightrope walk with compassion and curiosity balanced at either end.
Of course, it’s not all guilt. After my immediate anxiety fades, I am generally left with an overwhelming sense of gratitude. Patients and doctors alike have given me their time, their knowledge, and their trust, all with the expectation that I just learn. The kindness and empathy I am shown as a student blows me away. They say it takes a village to raise a child- it could also be said that it takes a village to teach a med student. This gratitude goes both ways- patients have expressed that volunteering can help give a sense of purpose to an illness or experience. And studies have shown that teaching facilities have better patient outcomes than non-teaching facilities- so having learners around must be good for something. In the end, I know I will be a learner for a long time- some might even say a life time. I hope I don’t lose the guilt or the gratitude along the way.