Ariana Witkin, MD Student, Class of 2015, reflects on her participation in the Interclerkship Ambulatory Care Track (InterACT). InterACT is a 13-week integrated clerkship which provides select third-year medical students with a longitudinal clinical experience grounded in the foundations of ambulatory medicine, chronic illness care and care for vulnerable persons.
Being involved in InterACT has been a formative experience in my time at medical school. Through this experience I was able to care for patients over an extended period of time. The relationships I made with my patients have not only been extremely rewarding, but have also helped shape the type of doctor I want to become.
It has at times both challenged and pushed my limits as a trainee, and also provided a supportive home base from which to grow. One of my patients in the Pediatrics Visiting Docs program died of a rare disease. I saw patients in my pediatrics clinic who dealt with complex medical problems and extreme social situations. During these times, I felt lucky to have such a strong, supportive team of mentors. My pediatric mentors, Dr. G and Dr. L, often made themselves available to me after work hours and by phone/e-mail. They taught me an impossible lesson-how to retain empathy and compassion towards a patient while maintaining professional boundaries and personal distance.
One patient and relationship that particularly stands out is my Visiting Docs patient, BG. BG was guarded and quiet when we first met. She wasn’t sure she wanted me involved in her care as she already had a doctor she knew and loved. Over time however, we were able to connect over her grandchildren and stories about her young life. This happened slowly. During my first few visits with BG she was always well put together. She wore brightly colored outfits, had her nails freshly painted and her wig on. After a few visits, she began to let me see her in her more natural state. She opened the door wearing her nightshirt; her nails chipped and her wig lay on the bedside table. Her apartment became more cluttered, with laundry piled high on the sofa and boxes of old photos and clothes strewn across the floor. During our last visit it was clear she had become attached to me. She was visibly sad to see me go but was excited about the doctor I was becoming. She was a proud mama bear and spoke as if she felt personally responsible for helping to shape my development as a doctor. Our visit ended with her calling me, “Dr. M junior”. This might not seem like a big deal, but coming from her it was a high compliment. Dr. M is her Visiting Docs doctor who she trusts to manage all aspects of her health. What BG doesn’t know is the large role she played in my learning about the doctor/patient relationship and the importance of establishing trust.
During its first 4 years (2010-2014) InterACT was fully funded with a grant from the Josiah Macy Jr. Foundation titled: Educating Future leaders in the Primary Care of Persons with Chronic Illnesses and the Medically Disenfranchised through Longitudinal Clinical Experiences.