I was lucky enough to be with my patient throughout the entirety of the semester. Although she rarely remembered my name and the details of my background, I could tell that she recognized my face and was happy to see me. This recognition and appreciation of my presence made this experience incredibly worthwhile, especially because my patient was not able to verbalize herself very well. While this made developing a relationship difficult, I was so happy that she enjoyed my presence. I realized, as the semester continued, that she could understand my speech even though she could not respond well. Since I tend to be more on the quiet side, this was a great exercise in creating conversation for me while being incredibly sensitive to my patient’s emotional reception of whatever topic I brought up.
Although I have had many interactions with patients in a healthcare setting in the past, I was impacted by the reversal of power in the patient-provider dynamic. In hospitals and primary-care settings, it seemed as though the patient was ‘always right,’ and the provider would be struggling to make the patient happy, often anticipating their needs and creating the most comfortable space possible for their care. In the hospice center in which I was volunteering, the patients not only often cannot physically have a voice, but the desensitization of the staff sometimes led to poor treatment of the patient. Not only did there seem to be this inadequate treatment of the patient by the workers, but the system of the Hospice institution itself stripped the patients of agency and power, leaving them more helpless than they already felt due to their physical deterioration. Patients were often left in the hallway in their wheelchair without being given notice of to where they were going next (i.e. to lunch, to activities, etc.) I understand the limitations of Hospice as a working system: the staff are overworked, the job is dirty and constant, and the patients can be unintentionally difficult to work with. However, there is much room for improvement in the hour-to-hour workings of Hospice and in the standards for provider-patient interaction such that the setting is optimized to meet the patient’s needs.
Before this Hospice experience, I had already cultivated an interest in primary care and general medicine (potentially with a specialization in geriatrics). Participating in this program has given me more impetus to enter this field because I see how much can be done in the way of improving the patient experience. On the other hand, this experience has also given me more interest in the policy component of medicine. Although I don’t have much of a background in that field, much of the insufficiencies of the system I have discussed might best be ameliorated from a political approach. This is something I have experienced in the other healthcare settings I have mentioned that I have had experience in already as well, and remains in the forefront of my mind as I prepare to embark into the ‘real world’ after graduation and focus on my future plans.