By Matthew B. Cantlon, MD

One of the most challenging aspects of my training was the limited development of physician-patient relationships due to a lack of patient continuity. In order to learn, absorb, and apply all that is necessary to become a competent physician it requires continuous change – from outpatient clinics to inpatient wards; inpatient surgery to outpatient surgery; spine surgery service to total joint service.  As a result of this constant change, it is common to have only one encounter with a patient during surgical training, often as a single outpatient or a single post-operative visit.  In many instances, a trainee may never “meet” the patient, and only assist in their surgery in the operating room.  This fragmented care can lead to a lack of ownership of patients and a deficit in perhaps the most rewarding parts of patient care: getting to know the patient and sharing in the patient’s improvements.

When there is an opportunity to see a patient more than once, surgical training programs may emphasize honing diagnostic or technical skills over eliciting contextual patient history that may or may not be directly relevant to the medical problem. I understand the necessity of this trade-off; operating on and managing a high volume of patients is required to develop technical expertise.  Time constraints, particularly as a novice, inevitably focus the patient-physician encounter on discussing the surgical issue, potentially overlooking the broader context of relatable patient experience.

Many of my most rewarding patient encounters have been those where I can observe the positive effects of interventions over multiple visits.  That longitudinal experience also affords the opportunity to get to know patients on a deeper level.  Over my first several years of practice I have had been fortunate to hear remarkable stories from my patients about storming the beaches of Normandy, assisting John Charnley with his first total hip arthroplasty, and negotiating international treaties for the United Nations.  It was the lack of these personal interactions which made training particularly challenging for me.