‘Training’ may be over, but learning won’t end

The Boston Globe | July 3, 2013

By Kiran Gupta

The single-most important teaching I’ve taken from residency is not a lengthy list of diseases and clinical manifestations, but rather a mindset: one that emphasizes curiosity, teamwork, compassion, and doing better than the status quo. Medicine is art as much as science, and each patient is an individual who will challenge us to provide care that is just right for them. The coming years will mark a new phase as we move into different roles. Yet in many ways we will still be “in training.” For some, this will be formal, as fellows learning oncology, cardiology, and gastroenterology; others will serve as new primary care doctors learning to practice medicine more independently; and some will become hospitalists, leading teams of residents on the wards for the first time. Remembering a recent patient’s question about whether I was a doctor in training, I can’t help but smile. Even though residency is over, the answer is yes; I can’t imagine any other kind.

Looking past a patient’s crimes

The Boston Globe | May 10, 2013

By Kiran Gupta

At times, events in the world outside the hospital blur the line between the role we serve as doctors and our feelings as members of a larger community. It would be unrealistic to expect that physicians can simply control their internal thoughts and reactions when confronting situations like these. Our lives, after all, are embedded in the fabric of the society in which we live and serve, one governed by moral commitments and legal rules that give internal and external force to our shared sense of right and wrong. Yet it remains our professional obligation to ensure that those feelings do not alter the care we provide to each patient who comes before us.

Learning to see patients as more than a condition

The Boston Globe | April 4, 2013

By Kiran Gupta

Patients play a role as our teachers not just by enabling us to hone our skills as we practice the clinical application of medical knowledge. Equally as important, they remind us that in order to provide appropriate treatment, we must take the time to appreciate how their conditions affect them personally. Without viewing illness in the context of our patients’ lives, we as physicians cannot practice compassionate, effective, patient-centered care. To our patients, it doesn’t matter whether an illness is commonplace or rare. Understanding the hopes, fears, disappointments, and dreams our patients share with us as we treat them allows us to build genuine, empathic, human relationships, and makes us better doctors in the process.

Doctors have a duty to encourage patients to discuss end-of-life wishes

The Boston Globe | February 20, 2013

By Kiran Gupta

While many elderly and chronically ill patients designate an official health care proxy, few discuss their specific wishes should they later face life-threatening illness. Doctors have a duty to help facilitate such conversations. We must prompt our patients to speak with their loved ones about uncomfortable topics — including ventilators, resuscitation, feeding tubes, dialysis, and death. By asking the right questions, we can empower our patients to speak their minds honestly to their chosen proxy. Left to make decisions on their own, family members are often driven by guilt or fear. If we as physicians help our patients understand this, they can begin to have meaningful conversations with their loved ones that ensure the care they receive reflects their deepest beliefs and values.

The importance of listening to a patient’s history

The Boston Globe | January 2, 2013

By Kiran Gupta

Taking a patient’s history properly is important not only for providing optimal medical care, but also for helping us as providers find meaning in the relationships we build with our patients. Yet I sense that my generation of physicians is losing something precious, the very reason why many of us were drawn to medicine in the first place — time with our patients. In a system burdened with financial pressures as well as significant time and resource constraints, it can be easy to reduce patients to charts, labs, and a list of “to dos.” But caring for patients involves something more: It requires a sense of humanity. If we are to maintain this, we must find a way to change the current system so that we always have time to listen.

The barrier between doctors and non-English speaking patients can be greater than language alone

The Boston Globe | November 15, 2012

By Kiran Gupta

Studies have shown that patients who do not speak English generally fare worse in our healthcare system. They are often diagnosed with more advanced disease, have difficulty taking medications as prescribed, and spend more time in the hospital. Medical interpreters are essential in bridging this gap, lending meaning to our interactions with non-English speaking patients. Yet sometimes the barrier between patient and provider is greater than language alone, one that no interpreter, regardless of how skilled or compassionate he or she may be, can surmount.

Care can be delayed when transferred patients arrive with incomplete records and no notice

The Boston Globe | October 11, 2012

By Kiran Gupta

Complicated patients that require specialized clinical expertise or interventions unavailable at many smaller hospitals are often sent to large academic medical centers. Ironically, however, in seeking better care these “transfers” are often exposed to significant new risks in the very process of moving from one institution to the next. If we as providers are to ensure our patients the best care possible, the transfer process between health care institutions must be streamlined. Until such changes are implemented, those of us on hand in the middle of the night are merely plugging our fingers in gaping systemic holes in an attempt to keep the process afloat as best we can.

The blurry line between treating pain and feeding addiction

The Boston Globe | August 13, 2012

By Kiran Gupta

Treatment of pain is complicated – the complex pathways that lead to its sensation are still not well understood. As physicians, we constantly confront patients suffering from all types of pain; it’s often what brings them to the hospital or our office in the first place. But we must constantly walk a fine line. Failure to treat pain appropriately can cause unnecessary suffering and erode a patient’s trust. Yet overtreatment, particularly with powerful and addictive medications, can worsen quality of life, prolong hospital stays, and even cause life-threatening complications.

Limits on residents’ work hours may adversely affect patient care

The Boston Globe | June 27, 2012

By Kiran Gupta

To many outside the profession, the idea that medical residents ought to work such onerous hours is troubling. But new restrictions, though well intended, are contributing to a work environment that compromises our clinical education and ability to provide care in a patient-centered manner. They may even have negative effects on our levels of rest and personal happiness — the very outcome these reforms were intended to address.

Family members can sometimes keep doctors from focusing on patient

The Boston Globe | May 2, 2012

By Kiran Gupta

Questioning is an essential part of understanding and we as physicians encourage those we care for to be well-informed. Rarely, a patient or family member will try to pressure a physician to proceed in a manner the doctor does not deem appropriate. No matter how much duress a doctor faces in such circumstances, his or her highest obligation remains to provide clinically sound care based on the best evidence available. This can seem difficult when confronted by a frustrated patient or angry family. Though physicians are not required to proceed with tests or treatments that are not clinically indicated – doing so can often do more harm than good – the pressure to do something more is especially great when patients cannot advocate for themselves, leaving anxious family members to drive the dialogue regarding care.

Discussing end-of-life choices with patients

The Boston Globe | March 8, 2012

By Kiran Gupta

In most cases, patients arrive at the hospital expecting to receive treatment, get better, and head home. The alternative usually seems out of the question. Perhaps naturally then, it is shocking when a perfect stranger (albeit a well-meaning physician) begins asking deeply personal questions about decisions concerning the end of life that they may have never contemplated or discussed. Death is unavoidable but very few patients are prepared to discuss that possibility with a physician they have just met.

Juggling patients and parents, a resident struggles with where her loyalties lie

The Boston Globe | January 27, 2012

By Kiran Gupta

Residency is a tremendous privilege. It is a time during which patients allow us to learn from their illness and share with us the intimate details of their personal lives. But, it is also a time during which I can’t help but feel torn between my professional duties and personal responsibilities. Though my family, close friends, and even my colleagues understand, that doesn’t make it easier.

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