Medicine from the heart . . . Jeremy Konstam, SOM ’15


With Thursday Morning Memos on summer hiatus, the Daily Voice highlights a reflective essay from another source: an assignment from the Longitudinal Preceptor Program, which is part of the Doctoring and Clinical Skills class. Any member of the UMass Medical School community can submit an essay to the Daily Voice for consideration:

Second-year student Jeremy Konstam, who wrote this reflective essay for the Longitudinal Preceptor Program, describes an important lesson learned in the clinic.

A lesson in the art of stopping

I almost never look forward to going to the longitudinal clinical experience (LPP) required of first- and second-year medical students. It always feels like yet another “thing to do,” adding yet another responsibility to an already bullish army of small time-commitments. To make matters worse, I proceed to feel horribly guilty about feeling this way. I chide myself, “This is why I am ultimately here. This is your endgame—the whole reason for making the commitment you do academically. How backward is it that I can’t help feeling that this experience in clinical medicine is keeping me from preparing for . . . my career in clinical medicine?” Despite all of that, I almost always feel good about the time I spend at LPP after the fact, and there is a lesson here. It’s not only a lesson about why we do what we do, but also a lesson about how to do it better. It’s a lesson in the art of stopping.

It was a busy day—no different than any other at my preceptor’s clinic. We walked in to see a young man accompanied by his father. The visit was unremarkable from a clinical standpoint, a routine check-up. However, from most any other standpoint, this visit was indeed remarkable. The patient, cared for by his father as if he were a boy, was a mentally disabled man. Toward the end of the visit, my preceptor asked the father a question. His inquiry amounted to the same question with which he closes every appointment. Indicative of the personal relationships this doctor has built with his patients over time, he crafts the question slightly differently for each audience, but these many slight variations amount to the same query: “How are You Doing?” You with a capital “Y” because he is acknowledging that this is each individual patient’s time to be heard; Doing, with a capital “D,” because he is asking about the patient’s life, not the patient’s illness. In the case of this particular patient visit, it turns out that the father was not doing so well. His wife had passed away, and in addition to still mourning her loss, caring for his son full time was taking its toll. We spent another 15 minutes in the room discussing these issues with the father, ultimately providing a few resources to help him should he be in need of extra support. As we stayed in the room during peak hours of a busy day, my preceptor’s to-do list was no doubt piling sky-high. However, for every one of the extra 900 seconds we stayed, it felt as though this practice only cared for one family, and that family had the undivided attention of its doctor.

This experience brought something into focus for me. The stress of having to learn an extraordinary amount in a very short amount of time will quickly turn to the stress of having to see too many patients in too little time. When this happens, it will be our responsibility as physicians to avoid getting swept up in the stress, to slow things down, and to ask our patients how they Are. Patients deserve the warmth and completeness of care that my preceptor provided that day; they deserve a doctor who practices medicine with patience and perspective. In a fast-paced profession that perpetually impels its practitioners to go, every patient deserves a doctor who is willing to stop.