As a medical student at Harvard, Shara Yurkiewicz, MD, worked in both inpatient acute hospitals and rehabilitation hospitals. The striking differences between these two environments inspired her to become a resident in Stanford’s Physical Medicine and Rehabilitation program.
In a recent opinion piece in the AMA Journal of Ethics, Yurkiewicz argues that the “patient care collective” structure of the rehabilitation setting provides more comprehensive and holistic patient care than the traditional “physician-centered” structure. In a patient care collective, a patient’s entire health-care team — physician, physical therapist, occupational therapist, nurse, speech pathologist, psychologist and case manager — work as equal team members. We recently discussed her piece, and her experiences, via email.
What inspired you to write this opinion piece?
As a medical student, I had spent most of my time in a traditional inpatient hospital setting. When I did several rotations at a rehabilitation hospital, I was introduced to a less hierarchy-driven and more collaborative style of care. This style was particularly well-suited to the rehabilitation environment, where a patient is working with various team members for several hours each day. Encouraging open dialogue among team members, in an environment that nurtures this sort of crosstalk, is a healthier and happier place to work. Though each team member has clearly defined roles, there is less fear about upsetting a hierarchy should one member have questions or concerns... as a medical student I found this approach refreshing. By writing this opinion piece, I want to let others know that while a strict hierarchy may work for some situations, in the particular environment where I practice and where patients recover, a less hierarchy-driven approach works remarkably well too.
Could all medical environments adopt this approach?
I think care in an acute hospital setting can be both patient-centered and physician-centered. The difference is in the care priorities. Patients sick enough to be hospitalized are quite sick. First and foremost, their safety is paramount, even if it comes at the expense of their comfort. This may mean more frequent blood draws than a patient finds comfortable. This may mean keeping a patient with strict fall precautions in bed, even though he or she desires to exercise.
I think that the physician plays the central role on the health-care team because patients interact with fewer clinicians on a daily basis and their acute medical problems generally overshadow their functional or social ones. However, in my experience, there is still a good amount of cross-talk among physicians, nurses and social workers. The most useful part of the interdisciplinary relationship for me was knowing that the nurses are at the bedside for far longer periods of time than the doctors are. I depended on nurses to tell me about both acute and subtle changes in a patient’s medical condition. It’s an ongoing conversation, and the patient remains at the center.
How do you balance science writing with the demands of residency?
I’ve been writing since I can remember, and I joined the Yale Scientific Magazine on a whim during my freshman year in college. I also interned at Discover magazine during college and then at the Los Angeles Times as a science reporter through the AAAS Mass Media Fellowship. After I completed medical school, I worked as a medical reporter for MedPage Today while I applied for residency. Those were full-time positions that would be too difficult to maintain while also being a medical student or resident. But the desire to write remains. On the first day of medical school, I began a blog entitled This May Hurt a Bit to document my thoughts and feelings on the medical training experience. I’ve continued to blog and also to freelance for various media outlets since then. Balancing being a resident and writing isn’t easy. I write when I am inspired, when I have the time, or even better — both. Sometimes the time stamps on my writing appear at strange hours, which further reflects that!
Previously: At Medicine X, designers offer their take on why patient-centered design is top priority and Medical student to surgical patient: “You can learn a lot from watching. Thank you for letting me watch”
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