Thursday, October 15, 2015

Medical Students and Physicians: Who is Teaching Whom

Medical Students and Physicians: Who is Teaching Whom

I have recently returned from the 19th International Balint Congress in Metz, France.  What a privilege and an opportunity it is to share and witness the stories that are told in Balint groups with health care professionals from around the world.  In addition, we have the opportunity to listen to scientific papers that are presented by colleagues interested in a better understanding of the doctor patient relationship.  And finally, we have the rare experience of listening to three award winning medical student papers about a specific patient they have cared for and about, along with their reflections of what they have learned in this process.   By the way, the next International Balint Congress will be in Oxford, UK in the fall of 2017.  Check the IBF web site for info.

I continue to be intrigued by the Balint group process and I continue to believe one of the challenges in communicating the value of participation in Balint groups is demonstrating this value in some sort of quantitative way.  Why?  Because if you are not already converted, Balint group participation is not a simple formula for insuring successful patient engagement, and it does not provide simple answers for the challenges that some patients present, and it definitely does not easily or comfortably fit into the tight, fast paced and demanding schedules many physicians endure.  Why should I take even more time away from my private life to fix the problem of not enough time in my private life?

As I alternated attending first, my Balint group, and then medical student papers, and followed again by my Balint group, I observed an interesting irony in this juxtaposition: case presentations about challenging patient encounters in these Balint groups and described by experienced clinicians contrasted with medical student papers about healing relationships with their patients.  Stepping back to look at the bigger picture of the conference, it seems like this is a case of the apprentice teaching the master.  Students don’t need their own Balint groups - they have had the luxury of time with their patients!  In fact, moderators of student paper presentation often remark that it is nice to recall or be reminded of these meaningful experiences that seem less available in practice.  

Not only do these student essays provide evidence of a source of lost joy for physicians, but they also reflect (I believe totally unintentionally) a process that well functioning Balint groups seek to recreate - really getting to know the patient!  Being at this International Congress also gave me access to the recently published The student, the patient and the illness: Ascona Balint Award Essays 2015.   Reading these papers revealed a familiar process of:
identifying barriers to relationships or patient engagement, 
exploring biases and preconceived ideas, 
discovering patient stories, 
developing emotional self awareness 
and making emotional connections. 

In the Forward to this collection of essays, Don Nease, the President of the International Balint Federation, observes that we accompany these medical students on a  

 “…journey (that) passes through stormy seas of illness and emotion toward the  destination of holistic wellness, not just the absence of physical disease. That destination is not always reached, yet through it all the students demonstrate a need to maintain a sure feel on the rudder of their own emotions and a sense of trust in the winds of human relationships.  By accompanying their patients on their journey the students illustrate that even when physical healing is not possible a sense of wellness need not be lost.” 

(Thank you , Don, for this description!)

To me, one of the most interesting of Michael Balint’s suggestions is to consider the doctor as a drug - the idea that doctors impact patients in no less a way than do pharmaceutical agents.  In fact, I recently presented a workshop at the Forum for Behavioral Sciences in Chicago titled:  The Doctor as Drug - Teaching a Pharmacology of Relationships.  However, as I read these student essays and think about the outcomes of Balint group discussions, I wonder who this drug is most impacting - the patient or the doctor!  So, I read and reread the student essays and started to write the patients’ and the ‘doctor’s’ emotions reported by these students.  Stay tuned for that report!