A Patient’s Experience and a Dream

Last fall I conducted an alumni interview of a high school senior who was seeking early admission to my alma mater. Among a dozen or so standard questions, I asked, “So what do you want to be when you grow up?” Without hesitating, she said, “pediatric endocrinologist.” “Huh?” came my eloquent reply.

I have always been interested in how people choose – or end up in – their careers. For many, it is a series of chance occurrences to which they apply a grown-up version of “eeny, meeny, miny, moe” at the appropriate time. But despite all that, somehow most people seem to end up where they belong. Or perhaps they simply take a liking to one of the things they stumble upon and stick around long enough to make a career of it.

But when it comes to health care providers, one hears different stories altogether. So many of the caregivers I meet report that they always knew they would become a nurse or a doctor. Sometimes it runs in the family (“I come from a long line of nurses”). Sometimes the family runs it (“My mother always said I’d be a great doctor”). Sometimes it’s an urge from the gut (“I always wanted to help people”). But there’s a common thread in their stories: knowing from an early age that they were destined to be caregivers. They didn’t choose it as much as it chose them.

In the case of my interviewee, I heard an interesting variation on this theme. While she was saying “pediatric endocrinologist,” I was thinking that most medical students haven’t a clue what specialty they will practice; how could this high school senior know with such certainty? But it turns out that this young woman has had far more exposure to the health care system than most medical students—exposure that has shaped her life in immeasurable ways. Diagnosed at a young age with a complex chronic condition, she has spent nearly a third of her life as an inpatient. Given that context, the precision of her reply is easier to fathom.

What particularly fascinated me was the primary reason she gave for wanting to pursue a career in medicine in general and in pediatric endocrinology in particular. While it was her “amazing caregivers” who first inspired her to consider a career in medicine, the thing that really drives her ambition is her experience as a patient and her desire to improve the patient experience.

Having spent a cumulative six years in acute care beds at several different hospitals, this young woman truly has seen it all – the good, bad, beautiful and (sometimes) downright ugly. Generally, she had extremely positive things to say about the health care system and about her caregivers. But the extent of her exposure gave her plenty of time to think about how her experience might have been different and how future patients’ experiences will be different as additional knowledge is amassed – here she referred in particular to additional understanding around creating healing environments for patients.

Without criticizing or complaining – and with a clear appreciation for the complexity of hospital operations – she speaks eloquently and candidly about communication between caregivers and patients, the challenges of pain management, how her emotional needs were met (or not) and the impact of all of these factors on her own experience.

We had a particularly interesting discussion about the use of alternative therapies for pain management and doctors’ reluctance to use such approaches on pediatric patients. “Their hearts were always in the right place; they wanted to relieve my pain. But I was more interested in learning how to cope with my pain – an idea I had a hard time getting across to my doctors.”

I have reflected on this fascinating conversation many times since it took place – not only because it was an opportunity to spend time with an extraordinary young woman who truly has persevered against all odds, but because it crystalized for me the value of the voice of the patient. It served as a clear reminder of the importance of our work and how much we can learn from the very person we ultimately hope to help: the patient.

I am so very hopeful that this young woman – who is healthy now and who was just accepted early decision to my alma mater – will indeed become a doctor. We all know the old adage that doctors make the worst patients. I came away from this conversation thinking that patients might just make the best doctors.

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