My advice to graduating medical students on using technology but staying human.

The great Katie Couric shared some advice I offered over the weekend...

The other day, I was texting with legendary journalist Katie Couric (as one does). She was preparing to give the commencement address at the University of Massachusetts Medical School and she wanted to know what advice I would give to the graduates. Specifically, she wanted to find ways to encourage them to keep their humanity in a world increasingly shaped by technology.

I thought it was the perfect thing to focus on, especially as we stand on the edge of a new era of medicine aided by artificial intelligence. Here’s what I said, as Katie quoted me in her speech on Sunday:

“Use every bit of technology that you possibly can to prepare for each patient. But then drop all that and do the one thing that technology never can do; look at your patient and think “What would I do if this were my mother or my brother?” No machine will ever be able to know that feeling and it will change what you do, more often than you’d expect.”

The quotation may sound like a cliché but, I truly do this—both parts. I am constantly looking things up on my computer or phone between seeing patients, be it a paper on a particular medical topic, a phone app that has information that I need to know but do not need to memorize, or even results from prior tests and scans a patient may have had in our system that are likely to be relevant.

But when I walk in to the patient’s room, I absolutely put that all aside and try to have as human of an interaction as I can.

Here’s my approach:

Make introductions.

I introduce myself and I verify that I'm in the right room by getting the patient to say their name out loud, which I most often repeat back. (Once in a while this proves to be more than polite—sometimes patients have been shuffled around and it’s not a good scene to walk in and start talking about the results of a different patient!)

The other important introduction to make is anyone the patient brought with them who is also in the room. This has to be handled carefully. Assume nothing. A question as harmless as “Is this your spouse?” can be genuinely mortifying if the guest is the patient’s adult child. My go-to is, “And who did you bring with you today?” or “And how are you two connected?” Often, the guest of a patient plays an important role in the care, so it’s good to get a sense of that quickly. The more involved the guest is in the patient’s life or care, the less pleased they’ll be to have been ignored up front. Guests also sometimes are healthcare professionals, and they’ll usually volunteer this information. “This is my cousin. I’m also a doctor in the cardiovascular clinic across the street.” Good to know!

Make the human connection.

One way to make patients feel like I see them as a member of my own family, is to invoke my own experience. If I have any personal experience being a patient with the problem being looked at, I’ll often mention that. I’ve had mild low back pain my entire adult life. I’ve been fortunate with it, but there have been a few times when it flared up. Saying, “I’ve experienced this personally, so I have some idea of what you’re going through” often reassures patients that I am taking them seriously and am doing for them what I would do for myself.

If I’m deciding whether a patient needs to be hospitalized for further testing instead of getting the tests done later over a longer period, I will often say aloud, “I’m trying to think about what I would recommend to my own Mom or Dad, if they were here instead of you.” That’s powerful for two reasons. First, it leverages my advice Katie shared with the UMass graduates. Patients seem to connect to my connecting to them as if they were family. I can feel that they appreciate me applying the same conscientious thought and care to them as I would my own loved ones.

But if you’ll notice, I mentioned both of my parents. That allows me to expand on things, giving the patient a sense of how decisions are not “right or wrong” but hinge on individual patients’ situations and preferences. “I think my Mom would probably want us to get everything done all at once, which would mean hospital admission for a couple of nights. My Dad would be okay waiting, and would much rather not spend a single minute longer in here than necessary, even if that meant a couple extra outpatient appointments over the next week or two.” Doing this clarifies that there’s no “better” way. I’m not trying to “sell” them on staying or going. Instead, I’m trying to tailor the care to align with the patient’s individuality.

Make your professional experience a part of the conversation.

Patients feel reassured knowing that you know what you’re experienced—or being transparent that you’re not. (This one is getting easier, the further out from training I am.) When I sense that a patient is uneasy about the plan I have developed, I’ll often add something like, “I’ve seen many situations that are similar to yours.” This has to be done carefully, lest the attempt to instill confidence comes off like I’m minimizing. So, I’ll often say something like “one in a million events are exactly the types of scenarios we routinely see in the ER. Strange as it sounds, we do see a lot of this here.”

Alternatively, when I have not seen something before (or not often enough to have confidence), I’ll be honest about that and tell the patient that I need to “phone a friend”—that is, consult an expert.

For new doctors, this one is tricky because you don’t want to misrepresent things. In that case, lean on your hierarchy. “I’ve read about cases like yours before, but haven’t seen many. I think I’ve got a plan for you, but I’ll go over it with my supervising physician and we’ll loop back.” Patients can sniff out a newbie (no matter how hard you try to look and sound experienced), and they’ll appreciate that honesty. On top of that, if your supervising physician disagrees with the plan you’ve come up with (which will happen sometimes), it’ll be smoother going forward.

Make technology an open part of your workflow.

As I told Katie, using technology early and often in patient care can be extremely helpful. If I look something up, I’ll tell a patient. That’s not “cheating.” It’s going the extra mile. If I think a patient is up on technology I may say, “I just asked ChatGPT about this general situation, and it had some good ideas we can consider—and a couple of bad ones, so we’ll ignore those.” This accentuates the best use of artificial intelligence (and less advanced online tools): it’s great for making suggestions, but terrible for knowing what is really going on.

Closing thoughts: Great journalists ask questions that make experts think. I’m grateful to Katie for asking me something that made me consider my own professional practices so profoundly. It made me reflect on how far I’ve come as a physician, and that I’m proud to do this job. And as she said in her speech, I agree that technology will continue to enhance my ability to practice medicine, rather than replacing me or my colleagues, present and emerging.

One more thing: I’ll share the last part of the advice that I offered the graduating students (via Katie) but which didn’t make the speech: “Don’t just pretend that your patients are your family. Remember that they are!” From the genetic standpoint, this is 100% true. We are all cousins with common ancestors. We’re in this thing together. The more often we are reminded of that, the better.

Do you have any advice to graduating medical school graduates? As always, I’m interested to hear comments from medical professionals and patients alike…