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Professor and senior associate dean of engagement Janet A. Jokela discusses her article, “Celebrating internal medicine through our human connections with patients.” Janet shares moving stories from medical students who are discovering the profound importance of human connection, often for the first time. She explores how these early, sacred connections (like listening to a grieving patient or advocating for the uninsured) are the true reward of internal medicine, reminding us that medicine is not black and white. Janet champions the power of storytelling as a critical tool for patient advocacy and refutes the bias that technical backgrounds preclude compassionate care. This conversation is a celebration of the future of internal medicine and the empathy that defines it.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Janet A. Jokela, infectious disease physician and former treasurer of the American College of Physicians. Today’s KevinMD article is “Celebrating internal medicine through our human connections with patients.” Janet, welcome back to the show.

Janet A. Jokela: Thank you so much, Kevin. Great to see you.

Kevin Pho: All right, tell us what your latest article is about.

Janet A. Jokela: I was thinking about this. We recently celebrated a National Internal Medicine Day, and I was thinking, “Well, what could we do?” There are so many different things that we could focus on with that. One thing that came to my mind is some of the stories that I was hearing from students recently about their interactions with patients, kind of explaining in their personal statements why they were deciding to go into internal medicine. There were stories that were really quite moving and touching, and I realized this is exactly why we celebrate internal medicine.

Kevin Pho: All right. Give us some examples of some of the anecdotes and stories that you read.

Janet A. Jokela: We talked a lot about this with the students as they’re putting their applications together. One, for instance, involved a patient in the hospital with chest pain who was getting worked up. The student came in to speak with them and just spent a little extra time sitting and listening to them. The patient opened up about the fact that their spouse had recently died. No one knew; they hadn’t told anybody, and they were just overwhelmed with grief. They decided to share this with a student, and I think the student was perhaps a little surprised, a little taken aback: “Oh, whoa, you’re telling me this?” But then the patient was very grateful and expressed their thanks to the student, saying, “Thank you for taking the time. You made me feel safe. You made me feel comfortable to be able to share this with you.” So it’s things like that which are really touching, and which I think the students were surprised by. They also realize that the students, even in their limited roles, are able to provide care in a way that’s meaningful to patients.

Kevin Pho: So it sounds like just listening is as critical a medical intervention as ordering a test. And sometimes, ironically, students don’t have that same time pressure that physicians have and they have—I’m not going to say unlimited—but they have more resources just to listen to patients, and that in itself contributes greatly to the patient care.

Janet A. Jokela: Absolutely. That’s so true. They don’t have the skills yet to order whatever the test may be or all of that sort of thing. But what they can do is sit and listen to the patients, and what they’re learning is how valuable that really is. That’s exciting. It’s exciting to hear their stories.

Kevin Pho: One of the things you mentioned in your article was a bias against students with technical or engineering backgrounds. So how did you and your colleagues work to disprove that bias and nurture their compassionate side?

Janet A. Jokela: That’s a great question. Our medical school here in Urbana, Illinois, is the first engineering-based medical school in the country. That was one of the soft concerns that was mentioned early on: “Well, are your students really going to take care of patients? Connect with patients? They’re engineers after all.” You realize that was the bias. What really warms my heart seeing and working with all these students and seeing their application materials is that, absolutely, they can take care of patients. In the clinical world and the clinical experience working with experienced clinical faculty, they are right there and they get it. I think also, students are motivated to go to medical school to ultimately take care of patients in whatever fashion that may be, and that’s their focus. That was just really heartwarming to see.

Kevin Pho: Another story you described as a student becoming both a detective and an advocate for an uninsured patient. So how much of internal medicine is advocacy versus diagnostics? And I know your answer is going to be both, but tell us how important the other part is in terms of the advocacy for the patients.

Janet A. Jokela: You’re absolutely right. My answer would be both. We have to be able to do both, right? I think the advocacy piece is really important. The issue around advocacy is: Are we advocating within our practice, within our practice group? Are we advocating within our hospital system? Are we advocating with the insurance company? Are we advocating for state or national policy to help take care of our patients? So that advocacy piece, I think, is critically important in whatever capacity we may find ourselves in.

Kevin Pho: So one of the themes I’m hearing is that internal medicine physicians, or physicians in general, we’re more than just diagnosticians and ordering treatments and prescribing medications. There is a theme, especially in this age of AI where we always debate whether AI is going to replace doctors, that physicians are more than just people ordering tests, right?

Janet A. Jokela: Absolutely, absolutely. Patients really appreciate—as you know, as we all know—that human connection and that human touch. That’s what’s exemplified by our student stories: just these connections with patients that the patients value and appreciate and the students also really value and appreciate. They’re really getting a flavor and a taste of what it means to be a doctor, and that’s what’s so exciting.

Kevin Pho: Now, what do you think is the biggest barrier that prevents experienced physicians from maintaining sometimes that sense of sacred connection with patients? You’re reading these patient stories, they may not be exposed to some of the harsher realities that physicians face in medicine. So tell us about some of the barriers that prevent some of your colleagues or the physicians you’ve seen from sometimes having those same connections that you’re reading in those personal statements.

Janet A. Jokela: That’s a very important question, Kevin, and it’s something certainly I’ve thought a lot about. I think we all think a lot about that: How do we do this more effectively? How do we do this better? I can’t help but think it’s a time pressure, and also we know too much, and that’s OK. It’s important that we know too much. We know what the certain implications of certain decisions may be, whether it’s diagnostic testing or not doing a certain diagnostic test. Those are all things that we have to balance in our head and communicate with our patients. Certainly in clinic, we know—and in the hospital too—that there’s the next patient waiting. And how do we do this effectively and well? I think it comes down to time. It really comes down to time. And then probably also with that effective teamwork. We can’t do it all, but to be able to have a team around us to help us communicate some of these additional issues or whatever they may be, that I think is critical and makes more of these things possible.

Kevin Pho: Any stories or programs that you’ve heard, maybe the ACP is doing to help reconnect some of these physicians who have been in practice for a while, reconnect with why they went into medicine in the first place? Because sometimes when you’re practicing medicine and you get a little cynical with all the bureaucracy and the time, right? So any ways that these physicians can reconnect with why they went into medicine in the first place?

Janet A. Jokela: That’s such an important question too. Absolutely. ACP is all over this in so many different ways. I can think of a few just off the top of my head. One initiative that they’ve been kind of laser-focused on for a long time is this “Patients Before Paperwork.” The idea is to focus on decreasing administrative burdens. That’s a theme that carries through a lot of the advocacy work that we’ve been doing. We know that just by wishing patients had more time or telling people, “You must take more time with patients,” that’s not enough. But to be able to really focus on kind of the more administrative aspects of what we do to focus on decreasing those administrative burdens is huge. It’s really huge. I think another thing, even as we talked about before, is the national meeting. It is an inspirational meeting, but to be able to carve out some time, go to the meeting, connect with colleagues, and hear fabulous, inspiring talks—it’s inspiring. And that does remind us—certainly reminds me—why we went into medicine to begin with, and that I really take to heart.

Kevin Pho: In your article, you also call patients our most important teachers. What’s the most important lesson you personally learned from a patient’s story?

Janet A. Jokela: Oh my goodness, Kevin. Let me think. There are so many, as you know, but I think the most important is probably, again, just this focus on listening to patients. Really connecting with them and trying to best understand where they’re coming from and why they’re saying what they’re saying or why they’re making the decisions that they are and respecting that and working with them. We’re not here to force this, that, or the other thing on anybody. We work with our patients as partners, and I think it goes back to the very simple things like we’re talking about what the medical students do is listen. And I think to really listen with them and connect with them as best we can and work together with them to help them make good decisions for their health.

Kevin Pho: So you also write in your article that medicine, of course, is not black and white, and you come from a school that is more traditionally known for engineering, which is obviously very binary in terms of their training, right? Right or wrong answers. How do you teach students, especially from technical backgrounds, to become more comfortable with ambiguity going forward if they decide to pursue medicine?

Janet A. Jokela: That’s another really important question. I tell you, Kevin, it makes me think too about my own experience in medical school. I was expecting—I don’t know why, but I just was—a very black and white sort of experience. “Like there’s this problem, you do this; there’s that problem, you do that.” And I learned that wasn’t the case. There’s a lot of gray in medicine. That took some time, certainly as a student then as a resident, to continue to learn these things there, but it took some time to adapt to that concept.

I think the more we can talk about that with our students and again connect with our students in the same way we’re talking about connecting with our patients, that makes all the difference. To be able for our students to work with experienced and excellent clinicians who can help teach those concepts is critical. That’s how we’ve approached it, and that’s how I’ve approached it. And it seems to be the best thing that we can do.

Kevin Pho: Like you said earlier, there was a day to celebrate internal medicine. For those medical students who listen to this podcast, tell us the type of questions that they need to ask themselves to determine whether internal medicine is the right path for them.

Janet A. Jokela: That’s another hot-button topic. A lot of the times when I’m talking to students about this in terms of students who are trying to decide on a career path, one kind of branch point, if you will, is: Are they interested in procedures or not? More of a decision-making and non-procedural specialty or a procedural specialty. That helps, I think, to kind of begin that path in terms of making the decision.

And then once that decision is made, then you start thinking, “Well, what do you like? What are you passionate about? What did you like about the different attendings that you worked with? What inspired you? What makes you want to get up and go in every day?” The third thing that I’ve done with students who are really trying to decide—like say they’re trying to decide between maybe neurology and internal medicine—is my advice is: Write a personal statement. Which one is easier to write? And listen to yourself, listen to your gut. And then kind of go in that direction.

Kevin Pho: We’re talking to Janet A. Jokela, internal medicine physician, former treasurer of the American College of Physicians. Today’s KevinMD article is “Celebrating internal medicine through our human connections with patients.” Janet, as always, we will end with some take-home messages that you want to leave with the KevinMD audience.

Janet A. Jokela: Thank you so much, Kevin. I think a few points. One, I think the future of internal medicine is in good hands just based on what we’re seeing with our students. Our students are compassionate. They are there for the patients, and that’s inspiring. We’re so proud of them. I think the future is in good hands.

And then the power of stories. We listen to our patients, we listen to their stories, and then it’s our responsibility as their physicians to help share their stories, to advocate for them and to help them get what they need.

Kevin Pho: Janet, as always, thank you so much for sharing your perspective and insight and thanks again for coming back on the show.

Janet A. Jokela: Thank you so much, Kevin, and delighted to be here. Thank you.