Every month I walk up to Pelham Parkway in the Bronx and ride the Bx12 select bus to the Fordham section to visit my patient. She is a warm-hearted, middle-aged woman who has multiple chronic medical conditions and no longer works as a result. She spends her time watching her neighbor’s children and involving herself heavily in her church community.
During our visits, I spend time listening to her—developing a patient-based narrative history of her life that is revealed though stories about how she manages her chronic medical conditions, and about her involvement in the local church. I’ve really gotten to know what’s important to her as a patient and as a person.
It’s the kind of experience that I never expected to have during my first two years of medical school and I am grateful to be part of it.
As a member of a student organization known as PACt, the Patient Advocate Connection at Einstein, I’ve been able to see the real-world experiences and challenges patients face. It is humbling, to say the least.
PACt is special in that it seeks to improve patient care while also allowing students to learn about themselves, patients and the healthcare system. The hardship and systematic injustices that my fellow PACt members and I have witnessed have been unsettling. In a way I hadn’t before, I now wonder how fair our medical system really is. What can we change to improve the lives of our patients? How can I, an individual medical student, make a difference?
The Bronx has New York City’s highest poverty rate and almost a quarter of the borough’s residents are likely to rate their health as fair-to-poor. It is clear to many of us that, for the sake of improving our patients’ health and controlling costs in the medical system, healthcare needs to focus on more-robust models of patient-centered care.
Caring for Complex Patients
Two forward-thinking Einstein medical students, Kevin O’Laughlin and Hannah Rosenblum, recognized the need to focus on this issue in 2012. They wanted to establish long-term patient relationships early in medical school and so they formed PACt.
In PACt, first- and second-year medical students develop an 18-month long relationship with patients facing numerous social and economic hardships. Each patient has usually been diagnosed with multiple chronic diseases, and requires consultations with myriad healthcare professionals. Three faculty members help connect students with patients.
These patients need a tremendous amount of attention for their care to be properly coordinated. Some doctors may call them “difficult to manage,” but PACt believes they could benefit enormously from someone guiding them through their complex health issues in a system where care can be disjointed, confusing and inflexible. Such patients are often vulnerable and may not receive optimal care.
Beyond providing healthcare advocacy, PACt members also offer support that often goes beyond listening to symptoms or reminding patients of appointments. One student this year helped a patient navigate the legal system while he was applying for disability assistance. Another student made it possible for a patient to get an electric scooter to improve mobility and independence.
Patients as Teachers
The program is still relatively new, but already seems to be well received. In a 2013 survey we administered, 8 out of 11 patients who participated reported that PACt helped them achieve their care goals. In my experience, patients take great pride in helping teach medical students about what it’s really like to live with fragile health and challenging conditions.
Students likewise have found enjoyment in establishing deep relationships with patients. You really get to know someone over an 18-month period. There is joy in empowering patients and providing them with, if nothing more, an ear that will listen, hear their concerns and empathize.
One of the most valuable lessons, though, is seeing the system’s shortcomings up close. Many of the 24 students participating in the program this year expressed frustration at the larger systemic problems with healthcare delivery. We all worry that there is little we can do to lessen the headwinds many of our patients face.
PACt has stirred up many unsettling questions and I hope they will provide me with the insight to begin to think about how to improve the complex medical system that my classmates and I will one day inherit, and make us lifelong advocates for all of our future patients.
Editors’ Note: Caring for patients with chronic illnesses is a critical part of successful healthcare delivery. Last month, WNYC featured a segment on efforts by Montefiore’s care management team to improve care and reduce hospital readmissions and costs. You can read and listen to the segment here.