“This conference has made me realize that I truly am a healer. In training to become a physician, I had begun to forget that.”
So writes Dr. Maja Castillo, a second-year pediatric resident at the Children’s Hospital of New York (Columbia Presbyterian). Maja was trying to convey to me in words the impact of the recent Pangea Conference on her development as a pediatrician. She was inspired, while listening to Saki Santorelli‘s wonderful closing keynote presentation, to jot down these two deceptively simple sentences, and then to graciously agreed to let me share them with you. I think her sentiment is both a sad condemnation of our current physician training system and a wonderful promise of how it could be.
When I was a third-year resident at Mount Sinai Hospital in NYC, I felt so strongly that something was missing in my training that I developed a curriculum to help pediatric residents address their own feelings about working with very sick and dying infants and children. This “Crisis Counseling Curriculum,” as I called it, was designed as a structured process group for budding pediatricians to discuss emotional and ethical issues not otherwise addressed in their training. For those interested in reading more about this curriculum, you’ll find a summary in the journal Medical Encounter – click on the link for Volume 17, issue 3 (ME 2003v17n3). So many of my colleagues noted that, as medical school and residency progressed over a seven-year extremely stressful period, they were trained “out of” their natural desire to connect deeply with families and patients. I heard over and over again how it was “necessary” to withdraw from feelings in order to best care for critically ill children. Yet it is precisely this connection, this relationship, that plays such a huge role in the healing process. I worried then, and I continue to worry now, that we are teaching our best and brightest medical minds to be expert, unfeeling technicians.
Yes, medical schools and residency programs have devoted much lip-service to developing more humanistic approaches to training doctors. Yet, as Larry Dossey wondered in an essay for Alternative Therapies, “Where are the Healers?” Perhaps our medical school selection process is faulty – are we picking the wrong people? I don’t think so – when I served on a medical school admissions committee, I was impressed by the warmth, generosity and breadth of human experience applicants possessed. I think our system of medical education is at fault. We must do a better job of nurturing the souls of physicians-in-training, and I think we need to support opportunities for growth, like Pangea. What was different about that experience, I believe, was the focus on human connection and dialogue rather than on disease management. There was hope and compassion and talk of “being with” our patients rather than avoiding the difficult moments. We encouraged personal exploration and reflection, and we valued query and uncertainty. And we will continue to advocate for substantive changes in the medical school and residency and fellowship training processes.
Currently, the American Board of Pediatrics is spearheading the Residency Review and Redesign Project (R3P). The world has changed greatly in the 30 years since the last review process. We need to train pediatricians to provide comprehensive primary care medical homes for the increasing number of children with special health care needs and to understand the effect our environment is having on children’s health. We need a focus on wellness – on nutrition and lifestyle concerns. Many of the philosophies inherent in integrative medicine are naturally suited to help train physicians to be healers. There are groups like the Bravewell Collaborative, via its Academic Consortium, that are leading the way in this regard. I think one of the greatest roles the nascent Integrative Pediatrics Council can play is to support this educational transformation.