Partnering: how we teach, and how we give the best care

It’s summer time. For those of us who work in teaching hospitals, this has a whole extra meaning. It’s not just about hot days and beaches and summer vacations.

The new residents have arrived.

They are fresh from medical school, excited and a little scared. Here at Boston Children’s, the residents are an impressive group. They are all exceedingly bright, with lists of accomplishments that make me deeply grateful that Children’s accepted me all those years ago. They have learned a lot about medicine. What we teach them is about being a doctor.

This isn’t something you can teach by sitting people down and talking to them, or by on-the-job training. We teach them about being doctors by partnering with them in care.

In primary care, where I teach residents, the resident goes in and asks the questions and does the physical exam, and then comes and tells me what they’ve heard and seen. We discuss the patient, I go and do some questioning and examining too, and then together we come up with the best plan. The child gets cared for by both of us. Over time, the idea is that the resident does more and I do less. But they are never alone in caring for the patient—and that’s true throughout the hospital.

I like that we start new doctors off this way. Not just because this supports them in their new role, but also because really, in medicine, partnering never stops. Partnering isn’t just about teaching. Good health care is impossible without partnerships.

There isn’t a single doctor out there who knows everything there is to know about medicine and health. It’s way too big to know, and new information comes almost every day. Besides, fully caring for people requires skills that no one person could possibly have. We always turn to each other for help. We turn to specialists, to our colleagues, to nurses, psychologists, physical therapists, social workers, respiratory therapists, nutritionists, interpreters—there are so many people that can play a role in getting and keeping a child well.

Even the simplest health problem can be complicated—because people are complicated. Their environment, their supports, their resources, their emotions, their beliefs, their heredity…this is why we say that medicine is an art. Every single patient, every single family, is different and needs something different from us.

Which is why our most important partners are the patient and family. That sounds obvious, even trite, but it’s not always as obvious or easy as it seems. It can feel strange as the doctor, the one who is supposed to know everything and be in charge, to make joint decisions with a family. It can even more strange to let them be in charge, although sometimes that really is best.

One of the most important lectures in my first year of medical school was one I had in Histology class. The lecture had absolutely nothing to do with the microscopic anatomy of cells and tissues. The lecture Professor Goodenough gave us that day was about power. You are going to have a lot of power as doctors, he told us. The best thing you can do is to share that power with your patients.

“Being the hero or genius is great, but making the patient truly well is even better.”

It was inspirational, and I’ve never forgotten the moment, but it took me years to really understand what he was saying. It’s not just about being nice, you see. It’s about being effective. And over the years I’ve come to understand that power is best shared not just with patients but with everyone who helps care for a patient. We do things so much better that way. Being the hero or genius is great, but making the patient truly well is even better.

So every July, it starts all over again and the new, slightly scared faces appear and we have the opportunity to teach not just pediatrics but partnership. As we talk and examine and bring in others to help, we not only take care of patients—but show that the way to do it is together.