Walk with me
Future doctors realize the power of empathy through early patient connections
They seem an unlikely pair, a young medical student and a retired programmer. But when Tara Murty and Michael Furze find each other on the plaza outside Stanford Hospital, they embrace. And when they tell the story of their friendship, they take turns speaking, deftly picking up where the other leaves off.
They met in September 2018 — “It was like a blind date,” Furze said — as part of a class called Walk With Me for first-year medical and physician assistant students at Stanford University School of Medicine. The elective course pairs students with patients who have chronic and serious illnesses, or with their caregivers, for the nine months of the class.
At their first meeting, Murty and Furze sat on a bench outside the hospital. Over the course of an hour, Furze described his decadeslong struggle with skin cancer on his face and his shoulders, the surgeries that removed his nose and palate and then rebuilt them, drastically altering his appearance.
Murty told of her upbringing in Amherst, Massachusetts, and her decision to attend medical school. And they soon discovered similarities: Both are originally from Massachusetts. Both love to read and write. And both like spending time outdoors.
They’ve since developed a strong bond, meeting once a month outside the hospital, even on chilly winter days. Together they began writing a book, a sort of co-memoir in which they discuss their histories, their friendship, their experiences, cancer and medicine. Each time they meet, they hand over the clothbound journal, taking turns to ink their thoughts onto its blank pages.
Murty describes moving to California, adjusting to the sun and the “entrepreneur energy” of her new home. Furze writes of his recovery from alcoholism, his winding career path and his cancer, which is in remission. They’ve kept writing and maintain the monthly meetings, even though the class concluded months ago.
After the trauma of illness and treatments, Furze has found the friendship to be therapeutic: “She has shown me that my experience is of value to people like Tara who are learning how to be a doctor and healer. It’s simple talking with her. It has helped me sort things out.”
For Murty, the class had an unexpected bonus: “I thought it’d just be a learning experience,” she said. “But it’s been such a joy to have a friend in Michael.”
First- and second-year medical students typically spend little time with patients. They focus on learning the science behind medicine — anatomy, pathology, microbiology and pharmacology.
They practice patient exams on actors, and they interview people in the hospital, but these encounters are brief; they don’t get to know them personally, or learn their struggles with illness or the health care system.
It’s only during their third and fourth years that they start to encounter patients during their clinical rotations and under the supervision of physicians. Similarly, physician assistant students are involved in patient care only after completing five quarters of science classes.
But Erika Schillinger, MD, associate chief for education at the School of Medicine, said first- and second-year students had long been asking for contact with real patients beginning in their first weeks of medical school.
“These students very much yearned for an authentic connection with patients,” said Schillinger, a professor of primary care and population health. She also wanted students to develop an understanding of the patients’ views of medical care.
“We wanted to solidify empathy and compassion early,” she said. “We want our students to have an appreciation for the whole of a patient’s life, not just their illness.”
Several years ago, Schillinger began planning for a way to foster empathy for patients early on, working with Kim Osborn, the school’s director of education administration, and others. The result was Walk With Me: A Patient-Engaged Exploration of Health and the Health Care System.
The course was first offered in the 2017-18 school year to 32 students, each one paired with a patient or caregiver. The school offers other classes in which students meet with patients, but only for a quarter; Walk With Me lasts an academic year. Such courses are part of a national trend in medical schools to give students a patient’s perspective of living with an illness and navigating the health care system.
The pass-fail class meets once a month, and because it takes place in the evening, dinner is served. During the class, a faculty member and a patient speak about situations patients can encounter, such as trying to find their way around a website or having clinicians who fail to share information with one another.
Students then brainstorm in small groups about the situations, seeking better ways to offer care. They meet with their patients at least once a month; once a quarter, the patients join the students in class.
Olivia Jee, MD, one of the course’s instructors, said that in traditional physician training, “you learn medicine from a clinician’s standpoint. You can get jaded and see patients as diseases. I like the idea of reminding students along the way of why they went into medical school.”
Lloyd Minor, MD, dean of the School of Medicine, added that the class helps train medical and physician assistant students to provide empathic, personalized care.
“One of the best tools a caregiver has is the ability to listen,” he said. “By understanding what patients go through, what their concerns are beyond the appointments and treatments, the students learn to care for patients as individuals who have their own goals and hopes for the future.”
The course requirements are kept to a minimum, given the demands on first-year MD and PA candidates. Students are assigned optional reading before each class, and they write a short reflection afterward.
At the end of the year, the students are asked to produce, with their patient partners, something that reflects what they learned from their relationship. Murty and Furze turned in their co-memoir, while other pairs have developed a recipe, composed a song, designed an app or created artwork.
The students arrive the first day of class “fresh and nervous,” said Jee, assistant professor of primary care and population health. “Sometimes they’re worried about how to talk with their patient partners, but over the year they develop genuine relationships.”
Not every pair develops the kind of lasting friendship Murty and Furze have, but they generally find a way to connect. One pair — assigned randomly, as all the pairs are — discovered they had attended the same junior high school in Hong Kong.
Many of the patients are volunteers from one of the hospital’s patient and family advisory councils, some are Stanford Health Care employees, and others are referred by Stanford nurses and doctors.
They are transplant recipients, cancer survivors and sufferers of various chronic illnesses, or they are caregivers of patients who are so ill they are unable to participate in the course. Students are expected to accompany their patients to one medical visit during the year.
Jee said she wants the students to leave the course understanding not only how to be more caring clinicians but also how to improve the practice of medicine overall. “I hope they learn that they can have a lasting impact on patients’ lives, and that they can change medicine into something that really is patient centered,” she said.
Furze signed up to be a patient partner for Walk With Me because, he said, “I wanted to help shape the minds of future doctors. I wanted to share with a medical student how difficult it is to navigate the medical process.”
As a teenager in Arizona in the late 1960s and early 1970s, Furze worked as a lifeguard and was exposed for hours to the blazing sun. “Nobody was really worried about sunscreen back then,” he said.
In 1983, Furze’s physicians found a large basal cell skin cancer on one of his shoulders and removed it. For years afterward, he regularly had small precancerous lesions removed. Then, in 2012, skin cancer developed on his face. He has undergone six surgeries as well as radiation treatment.
The therapist who helped him recover from the trauma of the illness and surgeries thought that if he sat on Stanford’s Patient and Family Advisory Council, it would help him view his experience as something that can benefit others. He took her advice, joined the council and volunteered for Walk With Me.
Getting to know Murty, he said, “humanized the health care professionals for me. I have realized what a major undertaking becoming a doctor is. It made it possible for me to see doctors as people who are able to make mistakes as well as treat disease.”
Murty, an MD-PhD student, registered for Walk With Me because she thought it was “a really special opportunity to get to know a patient personally.”
Once she becomes a physician-scientist, she hopes to conduct medical research that’s informed by problems she encounters in practice. Next year, she plans to pursue the PhD side of her degree, working in the lab of Crystal Mackall, MD, the Ernest and Amelia Gallo Family Professor. Mackall, who specializes in pediatric cancer, is conducting studies of CAR-T cell therapy, in which patients’ own immune cells are genetically modified to fight cancer.
Murty said that telling Furze about her laboratory work confirms her desire to conduct cancer research. He’s curious about her projects, which spurs her to seek new discoveries: “The projects may not yield results that change patients’ lives immediately but can certainly give them hope,” she said.
She added that Furze has shown her “how cancer impacts lives in so many ways.”
“Michael’s friendship has reinforced in me the kind of doctor I hope to be — one who cares deeply about the physical, mental and emotional health of my patients; one who understands my patients’ lives, joys, vulnerabilities and fears; and one who is a partner to my patients,” she said.
“There’s so much value in knowing the experiences of patients. I’ve learned that some of the best care doesn’t have anything to do with knowledge. It’s just about listening and respecting a patient’s concerns.”