Throughout my life, I have been trained by Jesuit institutions. I have loved all of what they have prescribed – to “find God in all things,” to “care for the entire person,” to “be a woman with and for others.” But the most important pillar that I have gained from these educational institutions is to have a reflective mind – the ability to ask why and dig deeper into a problem, a thought, an action, a response. And then, to simply take a non-judgmental look at what comes up and repeat the process in examining the reasons why a certain reaction was formed. It is from this that we can ultimately reshape ourselves for the better. Without this reflection, the idea of self-growth and progress is unattainable. As John Dewey explains, “We don’t learn from experience. We learn from reflection on our experience.”
Throughout my time in medical school, I have felt that my mind has constantly been tugged at for my full attention. During my first year, my brain was overtaken by the sheer amount of information that needed to be learned. Second year, my mind seemed to swim with anxieties surrounding step testing and the hours and hours required to spend alone training for each test. By the time third year came around, I was craving “normal” human contact. I was ready to be thrown into the world of “real doctors” and all that this could encompass. It was during this year that I felt my mind most tugged to reflect on everything I was witnessing. This captivating demand to reflect seemed to be stemming from a few different factors: I was noticing shortcomings of health care. I was seeing again and again the limitations of the system and the care team and wrestling with this unnecessary reality. I became more aware of the power that a leader has on a team and was seeing many great and terrible examples. Compacted with these overarching consistent themes, I was frustrated with myself for not grasping enough medical knowledge but also understanding that taking care of the whole person means so much more than just medical answers. And then I would feel sadness for my patients when this was not met. I noticed that the Jesuit pillars that had become something that I relied on in all interactions was not true of every health care connection.
At the beginning of my third year, I had a pivotal conversation with my mother. I was reflecting on my day by describing a passing encounter with the lead physician. He made an unnecessary, degrading comment towards a patient with a significant mental health history. Not only did this comment reflect disrespect for patients, but by coming from a person in a position of power, it enabled these comments to become commonplace (as shown when future physicians on this team repeatedly referred to patients with dementia as “demented”). As I was frustratingly replaying this to my mother, she simply responded, “El, you are building your toolbox. Don’t take that tool with you.” I have loved this analogy ever since. There are countless opportunities to add to our toolboxes experiences that will create environments that enhance patient care by exuding an air of inclusivity and compassion – like the physician that pulls up trash cans so that he can sit on them as he calls elderly patients darling. And there are many, many examples of tools that we must actively decide to not include in the toolbox. Without reflecting on these experiences, our toolbox is empty; we have nothing to show for our time and nothing to rely on when we are thrown into the chaotic world of being a real doctor. A quote by Margaret Wheatley put these ideas into words perfectly; “Without reflection, we go blindly on our way, creating more unintended consequences, and failing to achieve anything useful.”
The most important tool a medical student can have is the ability to reflect on experiences. To ask oneself many times a day questions like “Why did this interaction affect me?”, “What went well in this conversation?”, “I am feeling this emotion come up, why?”, “How am I showing compassion and vulnerability and how am I being shown this.” Without questions like this in medical education and encouraged by those in leadership, we simply miss out on shaping the next generation of medical professionals to engage in an extra layer of human care, one that I argue is essential.
Elizabeth Dorchuck is a medical student.
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