Isn’t It About TIME?
THE TULANE INTERNAL MEDICINE EDUCATION FUND
TIME, the Tulane Internal Medicine residency Education Fund, was established following the devastation of Hurricane Katrina. It was during those dark days that the truth the profession had
long suspected became undeniably evident: resident physicians play a powerful role in the delivery of healthcare in any system in which they work, and an exponential role in improving that healthcare by educating medical students.
In the days following Katrina, not one of Tulane’s residents left their post. Despite the absence of water, electricity and sewage, the residents maintained their professionalism and fulfilled their duty to perpetuate care in the three hospitals in which they worked. Over 2,000 people resided in these three facilities for five days; only three patients died during this time. And in the days that followed, with no promise of pay, recognition or credit, the Tulane residents engaged in a 24-hour-a-day marathon contribution to the healthcare of displaced New Orleans citizens. Within one month, the Tulane residents logged over 12,000 hours of community service in shelters such as the Alamo Dome, the PMAC, and the Cajun Dome. At the end of that month, the residency rebuilt itself and resumed training in the three cities that predominately housed its patients: Houston, Texas; Alexandria, LA; and New Orleans. The residents stationed in New Orleans erected six brand new clinics in the city… even while the city was technically closed.
And of this remarkable story, what can be learned? First and foremost, you reap what you sow. Great character is not born out of crisis, it is revealed. It was the day-to-day lessons of professionalism, taught by men and women of great character that enabled this remarkable feat when the crisis did present itself. But as important, is the lesson that medicine is an art still best practiced at the bedside. Even in the absence of utilities and technology, care continued, suggesting that the core of medical care was not the technology, but the physician-patient relationship. There is no technology that can supplant carefully listening to, and caring for, a patient. There are no medicines than can replace the genuine concern of the sincere physician. The days following the storm proved that.
Some would say that the Tulane Internal Medicine Residents were lucky…. they overcame overwhelming odds for the opportunity to perpetuate their mission of providing care to the underserved. But it was not luck. The crisis revealed what had been in development for years before the storm… a program that was founded on teaching residents how to care for patients at the bedside… A program that maintained the art of the physical examination, and taught it religiously; if only because it brings the doctor and the patient into therapeutic proximity… A program that teaches listening as much as hearing… A program built on genuine concern for the dignity of each patient, regardless of race, socioeconomic status, religion, or past deeds…
And once again, isn’t it about TIME? For the values that led to the success of the Tulane Internal Medicine Residency Team are sadly slipping away from medical education in most quarters of the world precisely because of a lack of time. Each new technological advance inspires more wonder and fascination: it is easy for a curriculum to gravitate to the newest toys acquired by the medical institution; bedside medicine is squeezed out because there is no more time. Medical knowledge continues to escalate at an exponential pace; it is easy to replace the art of bedside history and physical examination with lectures on the newest advances in medical science, because there is limited time. Faculty physician’s time continues to become more and more precious… shared amongst an increasing number of duties, it is easy for faculty to pass on the opportunity to teach the art of bedside medicine. There just isn’t enough time.
But the long-forgotten solution to medicine’s problem with time rests with resident physicians. They do have the time to teach medical students, and they remember the time when knowing how to interact with a patient at the bedside was a foreign concept. These are the people who are directly responsible for the lives of their patients; they spend ten-fold the time at the patient’s bedside than do their faculty supervisors. They are the ones who are there at all times in a night… when a child is born, or when a patient relinquishes the fight against death. They are the ones who take the time to call the family in the middle of the night to break the heart-breaking news. Because they have time, they are our profession’s hope for reviving the bedside skills that made medicine humane. And because they have TIME, they are the ones that are best able to teach our student physicians these sentinel skills. And in learning to teach these valuable skills, they are the ones who will find refinement of their own patient skills. But it is time that they have, and support that they do not. Isn’t it is about TIME that an educational fund was created to empower them to do so? Yes, and this is the reason that the Tulane Internal Medicine residency Education fund was established.
TIME is dedicated to empowering resident physicians to provide directly observed instruction in the art of bedside medicine for medical students. The Clinical Diagnosis course at Tulane has long-been devoted to this concept: ninety percent of clinical diagnosis preceptors for first and second-year medical students are Tulane Internal Medicine residents. But although the course receives support for its lectures, it receives no funding for empowering the residents to improve their instruction in bedside medicine. The TIME fund was built for this purpose. TIME has five cardinal goals:
- Provide resources necessary to teach residents how to teach bedside medicine, including acquiring patient historical information, performing the physical examination, and instituting compassionate conversations with patients and their family.
- Provide resources to support travel for one to two physician experts from around the world to provide inspirational messages and instruction in bedside medicine for Tulane students and residents.
- Provide resources for two awards of excellence for resident physicians who have demonstrated exceptional skill in the teaching of bedside medicine.
- Teach the virtue of social justice in the practice of medicine by empowering residents to teach students cultural competency: how to care for a diverse array of people in their practice of medicine.
- Teach students, by resident-physician example, that medicine can be a powerful force in re-engaging the disenfranchised patient, just by showing how to care sincerely for a patient. The hospital and clinic can be a sanctuary of hope as much as a facility for delivering science.
Physician, doctor and clinician are three words to describe the practice of medicine, though all three have at their heart one common denominator. “Physician” was coined by Aristotle as the person who was the ambassador between the physical world (i.e., the science of disease) and the patient; doctor comes from the Latin “docere” meaning to teach; and clinician from the French “clinique” meaning, at the bedside. It is about time that our profession returns to its proud and righteous heritage: it is about time that we teach our residents to teach their students about being an ambassador for their patients at the bedside. It is about TIME, and it is the TIME fund that will see this vision to its fruition. We welcome your contributions to this important and exponential initiative. For every student taught as part of the TIME-supported initiative, will someday be the type of resident that also teaches his or her students, and so on, and so on.
If you or someone you know is interested in contributing to this important initiative, please contact Dr. Wiese. The TIME Fund is tax-deductable, and operated by Tulane University.
c/o Jeff Wiese, MD
Tulane University Health Sciences Center
Department Of Internal Medicine, Residency Program
1555 Poydras Avenue, SL-50
New Orleans, Louisiana, USA