The Privilege of Patient Care: Often Experienced, Rarely Discussed

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To the Editor: During my intern year in orthopedic surgery residency, I was scrubbed into a total knee arthroplasty when I fully understood the privilege of patient care. Of course, I had observed plenty of these procedures throughout medical school and at the beginning of residency. I had even personally performed the dissection and closure of several. But this case was different. This, as my chief resident informed me at the scrub sink, was “my” case. Under careful supervision, I was going to be the one performing the major steps in the operation. It was the next logical step in the progression of training, he told me. I remember him saying this so casually, oblivious that this small “step” in his eyes seemed more like the sheer face of El Capitan to me.
I do not remember too many intraoperative details from that case. I am sure I made the usual embarrassing mistakes of all early trainees, and I am sure the case took longer than usual. I distinctly remember, however, the profoundly increased sense of patient ownership I felt after the patient arrived in the postanesthesia care unit. Just as the case was mine intraoperatively, the patient was “mine” postoperatively. No detail was too small, no task too menial for me to be involved. And while a micromanaging intern likely caused much (warranted) frustration among the floor nurses, the experience did crystallize for me a fundamental but rarely discussed aspect of training: that progression in training is ultimately about the privilege of taking care of patients.
Medical educators spend a great deal of time discussing competency-based learning, patient safety, graduated responsibility, and trainee autonomy—especially during transitions in training. Noticeably absent from these conversations is how such concepts are grounded in the underlying privilege of patient care. If we as a profession cannot articulate this privilege during the formal training of physicians, it is difficult to imagine how the next generation of doctors will find much joy, purpose, and meaning in their work.
I worry that medical schools and residency programs are producing ever more competent physicians who do not understand the privilege of their profession. That while medical graduates now understand more statistics, sociology, finance, economics, computer science, and biology than ever before, the ability to articulate the uniqueness of the patient–physician relationship is slowly being lost. If, however, the privilege of patient care is reinforced throughout the various transitions in training, medicine will take a significant step in returning to the reason for its existence: the patient.
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