In the latest post in our Why I Joined SPM series, guest blogger Dr. Nabin Sapkota shares his story of discovering that patients like to be taught what’s going on, and how this replaced what he’d lost when he gave up doing teaching rounds. Every “why I joined” post is inspiring to me, but this one brought me special feelings, especially this: 

With this newly discovered attentive audience, I did not miss the teaching rounds at all.

I discovered that people without any medical background can easily understand complex medical issues if you tell it to them in a language they understand.

Follow him on Twitter at @NabinSapkotaMD. You may also be interested in his book project “Symptoms and Diagnosis,” with the tagline “Ask not what the symptoms of a disease are; ask what the symptoms of a particular patient mean.”

Here is his post.
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I visited Nebraska for the first time when I was in my third year of internal medicine residency at John H Stroger Hospital of Cook County in Chicago. We loved the small town Mid-Western charm of Nebraska so much that we decided to move there. I started working in the community hospital and I loved my job. It was a sharp contrast from the overcrowded Chicago hospital where we were used to patients not fully trusting the doctors and always testing the waters to see if they are not getting the treatment they really need. In the small community hospitals in Nebraska, people had so much trust in their doctors, it sometimes overwhelmed with a heightened sense of responsibility. As I explained the different treatment options to the family and asked what they would want, the most common response I got was, “Doctor, what would you do if she was your mother?”

When people trust you this much, every medical decision becomes personal and you want to give back as much as you can to the community.

During my residency, I loved the academic setting. I admired the teaching and learning but I was not very comfortable with the idea of somewhat impersonal nature of the doctor patient encounters in teaching hospitals. When you are rounding on your patient with five other doctors in the room, how can the patient identify with you and trust you to make the best decision for you?

I love the personal nature of my hospital rounds in Nebraska where I can talk one-on-one with my patients and make the best decisions for the patients without any barriers. I did miss the teaching rounds but slowly I started using the whiteboard again. This time it was the whiteboard in the patient’s room where the nurses write down the vitals and other reminders. I started teaching patients a little more about their diseases with simple anatomic diagrams. I was amused by how much interest they had in the diagrams and what I had to say. With this newly discovered attentive audience, I did not miss the teaching rounds at all. I discovered that people without any medical background can easily understand complex medical issues if you tell it to them in a language they understand. It was so much more satisfying to teach this new audience than teaching the crowd of overworked medical students in Chicago.

My main goal of these teachings was to try to involve the patients as much as I could in making the medical decisions. I was probably trying to teach them more so that they would not have to ask me the what-would-you-do-if-she-was-your-mother question. But, as I started this practice, I realized the patients were happier and were recovering sooner as they were actively participating in their care. I then started writing a short bimonthly medical column in the local newspaper to teach the same thing to more people in the community. I was surprised to find out so many people still read newspapers in this day and age. It was a great pleasure when when patients would recognize me from the paper and told me they liked my column.

I enjoyed this process so much I wanted to do more. I started a project to teach more people. I wanted to reach out to people like those in my community who get their health care in community hospitals and trust their doctors to make the medical decisions for them.

I think the best way to teach medicine is to start from the patient. That is what they do in residency trainings to prepare doctors for the real world. I believe that this same approach will work in the community as long as you tell the story in a language that does not involve any medical jargon. The people in the hospital room were very interested in what I had to say because they knew it was about the person in the room. If I start the story with a real person that my readers can identify with, I may be able to capture their attention and have them learn about otherwise mundane topic of symptoms and diagnosis. It is mundane and unimportant until it happens to someone you know.

As I was looking to spread the words about my project, I wanted to see if patients are willing or ready to actually learn more about their diseases and participate in making medical decisions. I then googled several terms including patients, participate and medical decision making and was very happy to learn about the participatory medicine movement. I was very happy to learn that more and more patients are demanding to actively participate in their care and learn more about their diagnosis. I was also excited to see many doctors embracing this idea and actively participating in participatory medicine. I will be very happy to join forces with you in promoting this idea. I can help spread the concept of participatory medicine from big city academic university teaching hospitals to community hospitals where more than 50% of americans get their medical care. Unlike the big city university hospitals, patients in these communities need more encouragement to participate in their care and that is what I plan to do.

Thank you

Nabin Sapkota, MD
Omaha, NE