One pleasantly surprising thing about clerkship year was how often I would come across attendings whose level of dedication to their craft was jaw-dropping. But when I met Dr. Jessica Mellinger on the Medicine GI service and learned about the Michigan Alcohol Improvement Network (MAIN), a multidisciplinary alcoholic hepatitis clinic she and her colleagues had just started, it was a rule-out-TMJ kind of situation. Then I went to shadow her in the clinic and met Dr. Scott Winder, a psychiatrist. I won’t belabor the mandibular metaphors, but I will say that the humanity was palpable. Watching him put every single ounce of himself (which is a lot, he’s a pretty tall guy) into the motivational-interview approach he took with the new patient that day actually sent chills down my spine. I’m pretty sure the patient felt it, too.
Yet, I’m also pretty sure that alcoholism continues to ravage that patient’s already precarious mind and body. Indeed, despite the best efforts of MAIN clinicians, his prognosis is quite poor. It turns out both research and clinical efforts in alcoholic liver disease are woefully underrepresented in hepatology. The same is generally true of addiction within psychiatry. It takes a certain kind of person to persevere in building therapeutic alliance with patients whose addictions repeatedly sabotage their physical, mental and social lives. It takes a whole different breed to show up with sleeves rolled, radically loving and unconditionally ready to engage patients in a new line of change talk. After all, only with such an attitude is there a chance that the patient will leave feeling more empowered to confront their vicious disease than when they came in. That’s what the MAIN providers do on the regular.
My Branches Apprenticeship Elective in MAIN has so far afforded me opportunities in longitudinal patient care, systems improvement and research, training in addiction pharmacology and psychotherapy, and an orientation to integrated care models. But to me its greatest value has been in forging close relationships with people I was able to pre-screen as role models. When I then asked Drs. Winder and Mellinger to speak to the Internal Medicine and Psychiatry Student Interest Groups this past February, they brought the same kind of all-in attitude they bring to patient care.
So, my advice to fellow medical students: as you advance through the sometimes mundane, often challenging world of core clerkships, keep an eye out for those one or two people who when you meet them, a little voice inside you asks how this person even exists. Then ask them about their side gigs.
Don’t miss the next Dose of Reality.
Jack Buchanan is a fourth-year medical student at the University of Michigan. He completed graduate work in environmental philosophy prior to medical school, and plans to apply for residency in psychiatry. He likes to spend his free time traveling, practicing foreign languages, cooking, backpacking, snowboarding, and playing racquetball.