What is it about the way we teach that sets up behaviours in our students for the way that they practice? I noticed that many of our students don’t consciously think of their patients as fully human beings. I don’t think it’s intentional, or that they’re disrespecting the patients…they just don’t think of them as a person in the same way they think of themselves.
I believe that one of the major reasons for this is in the language we use when we talk to, and about patients. One of the ways we see this quite clearly is in the very formal and cold manner that students address patients when first meeting them. My favourite is: “Good morning sir. My name is John. I’ll be your student physio for the day. How may I address you?” Who talks like that? Somewhere in our curriculum, our students are being taught to speak to patients as if they’re a different species. Now, I know what objectivity and emotional distance are, I just don’t believe that they have much value in the clinical context. Healthcare is a deeply emotional space, and by teaching students to avoid that aspect of it we’re cutting them off from establishing any real connection with their patients, which will have a negative impact on patient care. This is also true of teaching. Don’t ignore the emotional context.
Could it be that as physiotherapists we treat patients as objects that are broken, and we bring that kind of thinking into the way we teach? Are we unconsciously treating students as objects that are broken in the sense that they’re not physios, and thereby graduating physios who treat patients as objects that are broken?
Many of my colleagues still talk about the patients they treat as the set of conditions they have (e.g. going to see the stroke in bed 12). We instruct and direct patients to do things, rather than working with them as part of a collaborative team. We do the same thing with students. We “educate” our patients by giving them a set of instructions and then call them non-compliant when they don’t do the home exercise programme because they didn’t understand why the exercises are important. But this the same thing we do with students when we similarly label them “non-compliant” because they didn’t study for the test or prepare for class by doing the readings we instructed them to. But, did we explain to them how preparing for class would help them learn? Did we actually structure the lesson so that the benefit of the preparation was explicit?
I think that sometimes as healthcare practitioners we believe that if we give the right instructions and control the right variables we’ll “fix” our patients. Isn’t this the same thing that we do with students – give them them the right instructions and the right content and then they must do their bit in order to be a good physio. With patients we often ignore the influence of factors like motivation, the capacity to endure discomfort, and emotional state on the qualitative outcome. We do the same thing with students, ignoring these factors as if they don’t have anything to do with learning.
I think we need to be aware that as clinicians we can sometimes make the mistake of thinking of our patients as the objects of our practice and the things upon which we act. We should be aware that this mindset can have implications for our teaching, especially when we think of students as empty receptacles into which our knowledge can be poured. We must also model for students that caring about someone else’s outcomes has real value in both professional and personal domains. We must work on the re-introduction of emotion into the clinical and educational contexts, and then help students learn how to manage their emotional responses to what can sometimes be deeply disturbing patient encounters.
Note: Of course these are generalisations and many colleagues do not treat patients as objects upon which to practice, just as many clinical educators do not treat students as the passive recipients of knowledge and skills.