Last update: 2009/12/18

A Doctor's Role

Naomi Otowa

Report: A Doctor's Role
Period: March 26, 2007 to June 15, 2007
Place: University of Pennsylvania, PA, USA
Division: Division of Pulmonary Medicine, The Children's Hospital of Philadelphia; Division of Cardiology, The Children's Hospital of Philadelphia; CHOP Newborn Care at Pennsylvania Hospital, Pennsylvania Hospital

Introduction
Nagoya University has an international exchange program, where students are given a chance to participate in clinical rotations abroad. I had the privilege to join the programs at the University of Pennsylvania (UPenn).
On a cold March afternoon, I arrived at the Philadelphia International Airport. I was filled with hope and excitement for the upcoming months of clinical rotation, but at the same time, I must admit, I felt a little lost and anxious.

A Doctor's Role
One of my purposes for going to UPenn was to see the different roles of a doctor. As a student, it is often difficult to determine how one should interact with his/her patients. How close should a doctor be to a patient? His/her family members? Should a doctor be close to a patient at all? How much in depth should a doctor share medical information with the patient? It is needless to say that the doctor-patient relationship has a great impact on satisfaction and adherence to medical care. In the pediatric population, the doctor-patient and the doctor-family relationship has even a greater importance. As a future pediatrician, being able to see and talk with many of the best pediatricians in the country was nothing less than a dream come true.

A Leader of the Medical Team
The first role I saw was one as a leader of the medical team. At the Childrenfs Hospital of Philadelphia (CHOP), various people are involved in patient care; doctors, residents, students, nurses, nutritionists, psychologists, social workers, child care specialists, and many others. The "team" has a mutual goal; figuring out what's best for the patient and guiding the patient through necessary steps. In order to reach this goal, the team members figure out their own roles in patient care, according to their specialties. The leader must be able to listen and gather the team's voices, compare with his/her own assessment, integrate them, and plan the next step. I saw that with a good leader, comes a good team, hence a good patient care.

A Teacher
The next thing I noticed, and greatly appreciated, was the doctors' role as a teacher. At CHOP, teaching is constant; during rounds, in the clinic, and on consults; in the patient's room, in the hallway, and in the cafeteria. In addition to these, occasional lectures were given before and after work. There were numerous chances to learn. "What do you think is happening to the patient?" "What makes you think so?" "How did you come up with that assessment?" The teachings were not merely on textbook facts, but also on how to think. The passion and patience of the doctors guided me to have a better understanding of the physiology and an organized flow to the scattered information I gathered from the books.

A Scientist
Medicine is often described as a collaboration of science and art. A doctor is a scientist and a specialist. As one of the leading research institutions in the country, many CHOP doctors have their own clinical research projects. Through these accomplishments, a doctor can reach out to thousands of patients all over the globe. Also, as a specialist, a doctor has a responsibility of informing patients and family members about medical facts. He/she must explain the situation, the assessment, the plan, and the prognosis without using medical gibberish. It must be clear and unbiased; just simple facts from the medical standpoint. Through this process, the doctor can "educate" the patient for long-term care. Providing patients and families with sound medical information, I felt, gave them a form of reassurance and a sense of control over the situation.

A Friend
A doctor, of course, is a professional. It is his/her job, and is not done for charity. Medicine, however, is special. The patient and the family are often desperate and anxious. A computer system may someday be able to go over the symptoms, physical findings, and laboratory and imaging studies and come up with a list of differentials, but only a human doctor can give comfort and reassurance. A doctor may need to become a "friend" for a patient to open up and allow the doctor to gather all contributory information. A doctor may need to become a "friend" for a parent to accept the situation and actively cooperate in the care of the child. The warm and embracing personality, although it may not earn him/her any money, is an essential part of being a good physician.

Outside the Hospital
What does a doctor do outside the hospital? As a child, I remember being surprised to see my elementary school teacher at a local supermarket.
One of my attending doctors was so kind as to invite me over for dinner at her house. She was a sharp, perky, and energetic doctor. She saw her patients as "people who happened to see me today because they happened to get sick," and not as "cases" or "the kid with a certain disorder." She treated the babies as if they were her own; she talked to teenagers as if they were her younger brothers and sisters; she talked to the families as if she had known them for years. My attending was still young, but I admired the way she interacted with other people.
One step outside the hospital, I began to see her different sides. In the car, she was singing and dancing to "Bruce Springsteen." On the phone, she was a daughter, asking her mom whether there were still eggs in the refrigerator. At the supermarket, she was a happy customer, trying to figure out what to cook for dinner. I felt closer to her in that 30 minutes than in the past week that I was with her on consults.
One step inside her home, she was a loving mother. The two-year-old angel was all over the place; running, jumping, throwing, singing, dancing, asking questions, tearing papers, drawing "mommy," and flushing pens down the toilet. My attending seemed to enjoy every minute of it. I enjoyed being a part of a home full of love and happiness.
There, she was not a doctor; she was living her life.
Through this valuable experience, I found out where her energy was coming from.

The Chameleon
The pediatricians at CHOP taught me one important thing; there is no single, "right" role for a doctor. A doctor is a leader; a doctor is a teacher; a doctor is a scientist; a doctor is a friend. Outside the hospital, a doctor is not a doctor; he is a caring father; she is a loving mother; a precious individual.
Between patients, the doctor changes. Between co-workers, the doctor changes. In and out of the hospital, the doctor changes. A doctor is a chameleon. The chameleon is flexible; he/she is able to assess and change himself to the most suitable and desired. The chameleon's foundation is the thorough understanding of the human physiology. The chameleon's mission is the pursuit of truth. The chameleonfs source of energy, above all, is love.

Three months at Duke Hospital

Fumiko Miyazaki

I got the chance to visit Duke University, which is located in North Carolina, US, for three months. During this period, I learned a lot about the foreign country and, at the same time, rediscovered much about my country through a variety of differences and similarities. In the circumstances which were entirely different from where I have lived ever, I needed to challenge and make efforts with every little step I took. And thanks to that fact, I really enjoyed the completely new days.

I did my clerkship in Pediatric infectious disease, Pediatric allergy and immune system and Pediatric endocrine disorders at Duke Hospital. It was only at a hospital of university and in pediatrics that I rotated and things may be different at other hospitals or in other departments, but what I found as the definite difference between medical scenes in Japan and in the US is "time" that doctors have. In the US, there are a student, a resident, a fellow and an attending doctor who are in charge of a same patient, and they come to see the patient repeatedly. Add to it, the connections between each department are close, so many doctors of many departments visit a same patient everyday. However, doctors in the US are specialized in the true sense of the word and it seemed that a doctor of a department mainly see problems which are related to his department out of all the problems that a patient has. And above all, I felt that the number of doctors in the US to a certain number of patients is undoubtedly bigger that that of Japan. With these reasons, the amount of what a doctor has to do in a day seemed to be smaller compared to in my country. This fact made it possible to practice"EBM"and"consideration for patients". Talking of "EBM", doctors often referred to literature in conferences and, even during rounds, they looked for literature with computers installed almost every corner in wards. It seemed that they were trying to find answers just when they got questions. Also, lectures and a variety of conferences are held very often so that doctors can keep improving their knowledge and skills. And as for "consideration for patients", I was surprised at how much time doctors in the US take to talk with patients during rounds or in out-patient clinic. It was for more that 30 minutes or sometimes about an hour, and doctors talked neatly to patients and their families about the diseases, therapies, side effects, prognoses and how patients should spent daily lives. Such long conversations may contribute much to make relationships between doctors and patients good. It was impressive to me that patients and their families didn't hesitate at all to ask questions to doctors.

Now when it comes to Japan, where doctors are killed by busyness and it's not rare that doctors take little time to talk with patients, how can we practice "EBM" and"consideration for patients"which we should learn from doctors in the US? As long as there's no plan to increase the number of doctors in Japan, all we can do is to expect each doctor makes efforts by himself. The great common point between doctors in Japan and in the US and what I am proud of as one who wants to be a doctor is that they all were trying to do their best in their circumstances.

Doctors and co-workers in Duke Hospital were all kind to this foreigner. They did lectures to me during rounds or clinic, listened carefully to my poor presentation and let me do interviews and examinations in outpatient clinic as one of their students. Also, the kindness of patients and their families helped me a lot, for they never hesitated to talk to me about their diseases and let me do examinations even when my English is awkward. Moreover, they were kind enough to encourage me! This fact made me feel really comfortable and thankful.
These three months passed so fast but was more productive than any other three months ever, with a far more surprises and discoveries that I could imagine. Lastly, I would like to express my deep gratitude to all the people who helped me in Japan and in the US though this exchange program. Without these supports, I could not have spent such fruitful time. I sincerely appreciate these help and their giving me this precious chance. Thank you very much.