In 1927, Francis W. Peabody published an article in JAMA titled “The Care of the Patient”. It was republished in the same journal in 2015, echoing an almost century-old preoccupation with care and compassion — and how it can be taught to the next generation of physicians:
“The most common criticism made at present by older practitioners is that young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine — or, to put it more bluntly, they are too “scientific” and do not know how to take care of patients.”
To those involved with the AMS Phoenix Project, the argument is incredibly familiar: the Project’s goal is developing health care providers committed to humane, compassionate, and person-centred care. The funded grants and fellowships have focused on implementing programs and interventions in education, work environments, and healthcare professionals’ self-identity, to tackle issues like patient engagement, burnout, and person-centered care, to name a few.
But the complexity and variety of the AMS Phoenix Project has made it challenging to identify specific definitions for concepts like compassion and person-centred care. That’s where the AMS Phoenix Lexicon Working Group came in — made up of two medical students (Nima Nahiddi and myself) and two faculty supervisors, Dr. Tina Martimianakis of the University of Toronto, and Dr. Rachel Ellaway of the University of Calgary. Our task was to develop a lexicon of terms used for and by the AMS Phoenix project, using fellowship and grant applications, as well as materials created by the AMS Phoenix Project itself.
My position in helping to create this lexicon came from my experiences as a first year medical student at the time, and from my background as undergraduate student in psychology, a freelance health journalist, and a Master’s student in the history and philosophy of science, where I studied critical social science perspectives on our concepts of health and disease.
As a medical student now finishing my third year, I can recall every time I’ve sat in a lecture on person-centered care: in each case, the speaker apologized for sounding “fluffy”. Sometimes it comes off as a joke, or sometimes it’s framed as a sincere plea to pay attention to the lecture, even though it’s on something that will never be formally tested. But what does that say about my medical school’s expectations about my learning? What does it say about how my instructors perceive what we, as medical students, value?
Many medical educators would be pleasantly surprised at students’ understanding of why it’s important to be person-centered. Many of us came to medical school with previous experiences as patients or caregivers. But as medical students, we often follow our teachers’ lead. Their attitudes shape the way we’ll discuss things like compassion with our colleagues in the future. If compassion is framed as “soft” every time we hear about it, eventually, we might start to treat it that way. Moreover, there are hidden curriculum moments that implicitly discourage students from speaking up about a lack of compassion in the healthcare setting.
What the AMS Phoenix Project has done is create a safe space for talking unapologetically about compassion and person-centered care. After weeks of reading and coding dozens of proposals over the summer, I found myself taking that space for granted: I felt saturated with the concepts of caring and compassion. It felt like a buzzword that had, with force of repetition, lost its meaning. But once I returned back to the rhythm of the school year, those concepts felt sorely lacking from my everyday curriculum.
Among the many meanings of compassion in the AMS grants, fellowships, and blog, we uncovered notions of humanism, burnout, communication, social justice, and patient engagement. With a unified set of underlying principles, we witnessed how authors deployed the language of the Project as scaffolding for a diverse set of goals. At the same time, this language posed limits: in what ways is “compassion” constrained, and what does it leave out? We noticed that very few projects included a quality improvement focus; moreover, while several proposals described the importance of patient engagement for compassion, very few included self-disclosing patients as authors.
These constructions of compassionate care are continuing to evolve with the changing healthcare environment. The Lexicon provides a snapshot of the current moment, and presents the opportunity to reflect on what that moment means historically, and looking ahead to the future of healthcare in Canada.
Erene Stergiopoulos is a medical student at the University of Toronto, and holds a MA in the History and Philosophy of Science and Technology. In 2016, she received the AMS-OMSA Medical Student Education Research Grant to study the experiences of medical students with disabilities and chronic illness, with the supervision of Dr. Tina Martimianakis.
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