We sometimes “cut” patients apart to assist in the diagnostic process. We must remember to put them back together; we’re charged with caring for their minds and spirits in addition to their bodies.
Lifelong Learning in Clinical Excellence | November 4, 2021 | 3 min read
By Aidan Crowley, Medical Student, University of Pennsylvania
This fall, I made my first cut in anatomy lab as a medical student. As I picked up the scalpel, the weight of the moment struck me, and I paused. This marked a milestone in the process of becoming a physician—dissection is a practice that has been passed down for centuries. After dissecting the thoracic wall, I set the scalpel aside to examine the incredible and intricate beauty of the human heart, and I couldn’t help but think back to the etymological root of dissection—cutting apart.
During an anatomy course as a college undergrad, I learned that I’d been mispronouncing dissection. It’s not “di-section,” or cutting in two, but “dis-section,” or cutting apart. In that moment of the first cut at the anatomy table, I realized that these first couple months of medical school have been, at their core, a comprehensive exercise in dissection. Beyond “cutting apart” anatomical structures, medical trainees are also taught to dissect the signs and symptoms that a patient brings to us. In mock encounters with standardized patients, we’re trained to gather data in the form of medical and social histories. We’re conditioned to deconstruct clinical manifestations into their causative pathways, to break down reported pain into a list of differential diagnoses, to “cut apart” patients’ stories to identify the source of their suffering.
In addition to anatomical and clinical dissection, medical school also entails a certain dissection of self. Becoming a clinician is inherently a process of dissection. We must unlearn acquired heuristics to train our minds to think like doctors. We separate studying from personal time to preserve balance in our lives.
Each of these forms of dissection—anatomical, clinical, and personal—is necessary in training, but they inherently carry risk. In dissecting cadavers, we risk replacing our conception of the patient as a person with a view of the patient as a biomechanical phenomenon. By cutting apart patients’ stories to separate out black-and-white signs and symptoms, our clinical reasoning may hinder authentic encounters with those who are suffering. In carving apart our own lives to create time for the mentally and emotionally demanding process of becoming a physician, we risk losing what makes us tick.
In a course I took on suffering, one of the sessions addressed the phenomenon of biomedical reductionism. The critical care doctor leading the discussion shared a key piece of wisdom that’s stayed with me: “Reductionism is often necessary in medicine in order to recognize patterns, reach a diagnosis, and treat a disease. But in taking the patient apart, we can’t forget to put the person back together.”
Reflecting on the concept of “dissection” and its role in shaping the clinician mind, the practice of medicine, and our own lives can offer an opportunity to balance it with “reintegration.” Dissection isn’t inherently bad—and may be necessary for learning about a person—but it must be coupled with reintegration. We can’t forget to put the person back together, and this can be accomplished through intentional reminders that we’re accompanying a human being who’s suffering. We must also practice reintegration in our own lives by setting aside time for processing and reflection, whether during the commute or by waking up five minutes earlier to set intentions for the day.
Here are three ways to balance dissection and reintegration:
1. Reflect on where you notice “dissection” in your clinical practice.
Do you find yourself dissecting patients’ complaints? Dissecting subjective reports into a set of signs and symptoms?
2. “Dissect” your daily habits.
How do you spend your time? Where in your life do you see yourself dissecting personal time from clinical practice? Do you actively build in time for emotional processing, either alone or with colleagues?
3. Practice reintegration. Remember to put people back together.
Remind yourself after each diagnosis that the clinical presentation you just dissected is also a person. In addition to reintegrating the patient, reintegration includes yourself—don’t lose what makes you you. Reintegration of personal time, relationship-building, reflection, and intention-setting into your daily habits will make you a better doctor for your patients.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.