The Path(ology) Less Traveled

Mr. S.  is a 30-year-old gay male with a 9-year history of depression, a TBI in 2011 from a bike accident, and a recent 7-month history of graduate school presenting today with concerns about his future. He appears otherwise healthy, height-weight proportionate, though slightly tired looking. He reports a lack of energy and thoughts of self-doubt. He denies any suicidal ideation, panic attacks, and insomnia. Upon physical exam, relevant heart sounds show no signs of compassion fatigue but a positive hypertrophic empathy for his patients and peers. Lab results reveal frustration levels are stable and within normal range, but motivational biomarkers are low.

Have you ever written your own SOAP note? What if they looked like the one above, taking into account all the factors that affect our lives? SOAP, by the way, stands for Subjective, Objective, Assessment, and Plan. It is a tool we use in medicine to document clinical interactions with our patients. I need to remember to explain these abbreviations because prior to medicine, I spoke a different acronymic language that could drive people crazy to an obnoxious degree. But I digress…

Let me get to the main point of this article. PA/medical/dental/graduate students are not superhuman people. They are human people doing super things. They are admired for their dedication, commitment, and endurance. But they are still people with vulnerable struggles, compromising life events, and chronic conditions. Your graduate education may start, but the rest of your life doesn’t stop, and this disconnect can bring with it certain complications.

In our studies, we – the students – are referred to as “normal” and it is implied that we will gain better clinical understanding once we start examining our “abnormal” patients. There is some truth in this. We will most definitely see more clinical pathology in our practice than we do in our classroom, but we must remember two things: Classmates are patients and patients are classmates. Classmates are dealing with diabetes, divorces, births, marriages, neurological disorders, and cancer remissions. Our patients are in the same boat. The only thing that distinguishes “us” from “them” is a name badge and some alphabet soup after our names.

Too often, we are entrapped in a world of deceptive dichotomies: He/she, this/that, them/us, self/not-self. Clinically, this makes sense, at least in our current pathological paradigm. But realistically, people are not an amalgamation of yes’s and no’s. They are a patchwork of fluctuant fibers contributing to an increasingly complex picture. No one is immune to this immutable fact. So, if you are a PA student somewhere out there reading this, remember to be kinder to yourself. If you are a patient, try to understand where your provider is coming from. And if you are a grad-student/patient hybrid, then be kind, understanding, and flexible with yourself AND your patients. Welcome to the path(ology) less traveled, a humanistic win-win.

6 responses to “The Path(ology) Less Traveled

  1. I attended your workshop at the Creating Change conference yesterday and I just wanted to thank you for the amazing presentation and for all that you taught me. I think you bring a valuable perspective to the medical field and that you’ll make a great contribution to it.

  2. Joseph, your insight and articulate expression never cease to amaze me! You are going to be an amazing provider. You are already an amazing student. Thank you for sharing your thoughts and feelings with all of us.

  3. What an fantastic post! Your humanistic approach warrants celebration. I appreciate that you identify and challenge the dichotomy that is so ingrained in our culture and in medical practice. Recognizing each person’s humanity regardless of role identity is imperative! I am so hopeful for the positive impact we can all make with this mindset. Well done!!

  4. You’re in PA graduate studies and you have time to write a blog post plus go around Creating Change in the world? Don’t kid yourself, you ARE superhuman.
    You continue to reveal your gifts. Having you as a friend is like having a birthday every month. Thanks for sharing this post, your humanity just keeps shining!

  5. I keep reading this, and it keeps inspiring me. Keep on keeping on, friend. You know I have got your back, and I know you have mine.

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