Join host Dr. Jonathan Weinkle as three student teams present innovative ideas for improving patient-centered care: from AI tools for iron deficiency anemia to narrative pain consults and pediatric simulated patients. Discover how listening more deeply can transform the way clinicians connect with patients of all ages.
How can healthcare become more human, more responsive, and more compassionate?
In Episode 7 of Healing People, Not Patients, Dr. Jonathan Weinkle speaks with six University of Pittsburgh students about creative, patient-centered projects they developed to address real gaps in medical care.
Sophia Smallwood and Thai-Hy Lam, propose an AI-driven support platform to help patients with iron deficiency anemia feel heard and connected, especially when their symptoms are dismissed. Ryan Ross and Trevor Staab introduce the idea of “narrative pain consults,” giving young patients uninterrupted time to tell their stories. Finally, Shruti Chandrashekar and Guillermo Cruz explore how using pediatric simulated patients in medical training can improve communication with children and teens.
Across all three conversations, a powerful theme emerges: technology and training matter, but listening matters more.
Top 3 Takeaways
About the Guests:
Sophia Smallwood: A sophomore neuroscience major at the University of Pittsburgh with minors in chemistry and religious studies. Sophia is passionate about patient advocacy and drew on her mother’s experience with iron deficiency anemia to help design an AI-based patient support model.
Thai-Hy Lam: A sophomore at the University of Pittsburgh on a pre-PA track, majoring in natural sciences. Tahi is involved in the Vietnamese Student Association and pre-PA club and is interested in how technology can strengthen patient advocacy.
Ryan Ross: A senior neuroscience major at Pitt planning to apply to medical school. Ryan helped design the concept of narrative pain consults after interviewing a friend whose chronic pain was repeatedly dismissed.
Trevor Staab: Also a senior neuroscience major at Pitt and aspiring physician. Trevor co-developed the narrative pain consult model to bridge gaps between patient experience and clinical decision-making.
Shruti Chandrashekar: A freshman molecular biology major on the pre-med track. Shruti co-authored a project exploring how pediatric simulated patients can improve medical education and help children feel more respected and heard.
Guillermo Cruz: A public health major on the pre-med track from Allentown, PA. Guillermo helped develop a practical budget and implementation plan for integrating pediatric simulated patients into medical training programs.
Healing People, Not Patients explores ways to enhance medical practice by infusing it with compassion, humanity, and a deeper sense of purpose, aiming to help healthcare professionals rediscover the "soul" of their work. Framed around the four questions of the Passover Seder, it probes how to transform medicine for the better, promoting an empathetic and supportive approach that empowers patients to create meaningful, sober lives, while drawing on Jewish teachings about community and friendship.
"Our theme song, "Room for the Soul," is available on Bandcamp at https://jonathanweinkle.bandcamp.com/track/room-for-the-soul."
Dr. Jonathan Weinkle is an internist and pediatrician who practices primary care at a community health center in Pittsburgh. He strives to be a "nice Jewish doctor" focused on patient-centered healthcare, emphasizing effective communication and holistic well-being.
He teaches the courses, “Death and the Healthcare Professions” and “Healing and Humanity” at the University of Pittsburgh, authored the books Healing People, Not Patients and Illness to Exodus, and runs ‘Healers Who Listen’, where he blogs on healing and Jewish tradition. Once an aspiring rabbi, he now integrates faith and medicine to support other physicians and his own patients.
🌐 Website: healerswholisten.com
🔗 LinkedIn: linkedin.com/in/jonathan-weinkle-3440032a
📸 Instagram: @HealersWhoListen
📘 Facebook: @JonathanWeinkle
[00:00:00] Hi. So as promised, I'm here first with Sophia Smallwood and Tahi Lamb who have a very interesting project to present to us, but I'd like them to introduce themselves first. So, Tahi, could you tell us a little about yourself please? Yep, of course. My name is Tahi Lamb. I'm a sophomore at the University of Pittsburgh, currently majoring in natural sciences on a pre-PA track.
I am currently in VSA, which is the Vietnamese Student Association Committee, and also the pre-PA club. Great. Okay. And as some of my listeners may know, I have a fondness for PAs that worked at Chatham University in their PA program as the medical director for 10 years. So I wish you luck. And, both Pitt and Chatham have excellent PA programs, so hopefully we'll be able to keep you in town one way or the other.
Sophia, what about you? Tell us about yourself. Hi everyone. I'm Sophia Smallwood. I'm also a sophomore at the University of Pittsburgh. I'm a neuroscience major, minoring in chem and religious studies, and I am the vice president of our Polish club here at Pitt. [00:01:00] Fantastic. And Sophia was. Modest enough not to mention the other connection outside of these classes that we have, which is that she is currently serving on the student advisory committee for the, conference on medicine and religion, which I chair.
So that's an exciting sort of outside of Pitt responsibility. Alright, so I wanna start with just sort of the simple question. Your project centered around. A very common disease that nonetheless gets overlooked a lot. 'Cause it's actually a lot more common even than we believe, which is iron deficiency anemia.
So tell me what the project is that you came up with about better treatment for iron deficiency anemia. So basically we had, Sophia's mother who went through trying to find out whether or not she had iron deficiency anemia through her doctors. And she had went through multiple physicians and she explained her symptoms.
And overall she did not get a satisfactory [00:02:00] response or type of care she wanted. I'll probably let Sophia talk a little bit more since that was her mom. but we did come up with a solution. It's more of a AI solution considering our future right now in the world. And it's a deep learning model that we had gotten inspiration from another deep learning model, called My Aava, which focused I believe on PCOS patients.
And it allows you to see. All their background and let them communicate with other people. It's like a group chat where they can explain their symptoms and see what other symptoms other patients have to see where they may lie in the condition and where they are in the progress of diagnosing it and how they can help themselves and connect with other people during it.
So, Sophia, you as mentioned, this is a story that's very personal for you. And Tahi talked about. Your mom having trouble getting the kind of answers that she was looking for, what happened to her that [00:03:00] made her feel like she was kind of getting shut out of the care she needed?
Alright, so when my mom, like right after she had my sister, a couple years after that she had gone through a couple hematologists after being referred by her PCP or her ob gyn. The OB GYN and the PCP were hesitant to help her with the issue, so they wanted her to see a hematologist first, and so she went through the first hematologist.
And I don't think they really clicked, but the one that was more impactful to her was her second hematologist. That was like a less than great experience. And I actually got to meet this hematologist over break while I was shadowing. And so it was a weird situation for me because I knew the history.
I was like, oh dear. But yeah. So this particular hematologist is very by the books. totally goes off of numbers and doesn't really take any lived experience into Diagnostic criteria. So [00:04:00] her ferritin was like 33 and the threshold for treatment iron infusion was 30. And so she was right there at that border mark and she was very symptomatic and he basically told her to take some iron pills even though she can't tolerate the iron pills.
she had known that for a while. And so she ended up. Not seeing that hematologist anymore and switch to one. That is great. And she's actually both of our hematologists now. She's wonderful. And this, hematologist in particular was really good about just having that pull up a chair mentality. And really listening to her and getting off the computer, being fully present while she was there in the room with her and really listening to her symptoms and her lived experience.
And they had decided that she would get a series of iron infusions and we're still seeing her today, but she was outstanding. She did a really great job, was really thorough, and she really listened to the patient. [00:05:00] Sure. there's so much to unpack in that, little story, which is great. This is what I love.
And I want the listeners to notice that I think it took Sophia like maybe two, two and a half minutes to tell that whole story if that I'm watching the clock and we've been on less than six minutes and. It kind of highlights one of the themes of our class, right? Which is that you don't need that long of a time to let somebody talk uninterrupted and all sorts of important data comes outta there if you're paying attention to it.
I love the mention of the pull up the chair mentality. We'll talk about that in a second. Getting off the computer and really paying attention. I'm gonna come back to those in a second, but tell me a little bit about, you said she was very symptomatic and. The one doctor wasn't taking into account her lived experience.
So what experience was she living? Obviously one of them was iron pills suck. I don't like Taking them, but what else was going on ? So her main symptoms, she was super fatigued and she was having like. I guess like hot flashes sometimes. And [00:06:00] she had other symptoms too, but the main one was that she was so exhausted.
Short of breath. Mm-hmm. It was like your really classic iron deficiency symptoms when it gets pretty bad. Mm-hmm. and the doctor basically chalked it up to your mom. So he definitely took that into account, maybe a little too much, but it was almost like he used that to dismiss the situation.
For sure. As far as like other lived experiences that the other hematologist took into consideration, the first thing she did was rule out a bunch of other like blood disorders that we may have a family history of. So that's one thing that was important, really assessing like the potential for some genetic predisposition for something.
And our model will also get into like the genetics behind it. 'cause there's a genetic component that we wanted to put into our model as well. And then I think that was like one of the main things. And I think just the quality of life was not great. And I know in [00:07:00] our paper I found a study that talked about, it was from actually a retired hematologist that worked at Pitt her whole life.
And she was touching about how the quality of life for these women with this illness is really poor. And they can actually feel a lot better than they do. Mm-hmm. I guess the overarching point is just that I guess as a woman, she was made to feel like that was the norm for her.
'cause that was all she knew. Mm-hmm. When she found out that it wasn't the norm, the first physician didn't really do anything about it. Okay. And there's lots of life circumstances where we make that mistake. You know, aging is another one, oh, well, you're getting older. What do you expect?
And, we're starting to realize that. Normal aging shouldn't necessarily involve like, rapid deterioration of memory, you know, total loss of mobility. Like there's a lot of things that we can do to make that better. Being the parent of young children shouldn't be any different, right? We need we ought to be thinking about that.
Tahi, I want to come back to you. Sophia made that point about pulling up a [00:08:00] chair, getting off the computer, and yet your intervention is very tech based. So explain to me how. Using something that is so high tech helps to be actually more with what we call high touch. Like how does that actually fuel sort of the individualized, personalized medicine?
So our model, it advocates for patients. So as Sophia was saying, how her mother kept feeling dismissed and it was the physician just talking and talking and never really pulled up that chair And listen, Even though it's high tech, obviously when our patient is in the room talking about her symptoms to the physician, the physician can put these symptoms into the database, but the patient can also as well.
And so for it to be high touch and in touch with everyone, I believe that. Since our model allows the patients to see other patients who have the same symptoms, who are going through the same things, it allows for that human connection to know the patient is [00:09:00] not alone and that the patient can.
advocate for their health. To be able to get the care that they need. And so, even though it is a little more high tech, more AI to accommodate what like basically the world moving away from papers and writing to more computer and databases things, it still allows for that feeling of humility and humanity inside our database to be able to keep in touch with your symptoms, keep in touch with everyone else and everything like that.
So you're actually promoting it as a way of connecting with other people who have the same to Sophia's phrase, lived experience, who you'd never connect with otherwise. And I'm guessing that you're working in some security features to make it better than just hopping into an affinity group on Facebook or Instagram or something like that.
Yeah. Which is decidedly not secure. Yeah. Okay. So, even though I'm pretty sure that in our model you can see how other patients feel, and then obviously we need [00:10:00] to go through AI training to make sure that every part of the system works correctly, that we're not leaking anyone's information by accident or providing anything that isn't relevant.
But what I really, really like about our model, which Sophia actually found was that. Although it talks about your genetics and your symptoms and everything that leads up to it, you can also explain. Like your background, who you actually are in the model, who you are and why these roles in your life maybe have contributed or maybe have not, or just your lived experience basically throughout this illness that you may have.
And yeah, I feel like also being able to See, those people, like yes, I have experienced this as well and I'm a mother or this, but I feel as though, even though I am a mother, which is what a lot of physicians say, oh, you're a mother. It's just stressed. You have kids this and this and this.
It's not just that you're a mother, it's because you have. Other underlying things that are happening or other things that might have been happening to you? Or just the [00:11:00] idea that, or the feeling of not being heard to these physicians that other people can connect?
So it sounds like it might, and it might be able to tease out like, yeah, this person has kids, but. Their last delivery was three years ago. So it doesn't make sense that they're just as tired as this person who just had a really complicated delivery and a lot of blood loss, and now they're breastfeeding.
Like all of those things that sap your iron stores are not going on with the person that I'm talking to. So that doesn't fit. Yeah. I can see that happening where I can see some pushback. Number one is right, we talked about. Clinicians having egos and somebody saying, why is this like crowdsourced thing, a replacement for, you know, my four years of med school and three years of internal medicine residency and three years of hematology fellowship.
Like, what do you think that this, you know, beehive of people with high school degrees is gonna do that? I don't already know how to do. So even though physicians may think that, I believe [00:12:00] that our system not only does it advocate for patients, but also allows physicians to collaborate with the patients.
So it allows physicians to see, oh, here's the more scientific part, here's what the textbook definition of the illness as well, but also. Because you are seeing how the patient feels or lived experiences, I feel like those physicians cannot only take what they learn, but also understand more clearly how the patient feels so they can both collaborate onto the patient's illness.
So it's not completely disregarding the physician and their learning and what they know. It's only amplifying their knowledge and what they know in order to completely heal the patient and allow them to understand like, yes, I'm here for you. Yes, I understand. Got it. So in a sense that you're also crowdsourcing the physician side of things.
And they may be able to learn from a colleague in the same field, you know, across the country who, for whatever reason, they've never met at a conference, they don't have any friends in common, whatever, but they're doing exactly the same [00:13:00] job and now they can share notes in this secure environment.
That's a great idea. I can see it though, being right. There's so many tools out there. You know, we talked about sometimes you don't even know what you don't know. How is somebody gonna come across this in the sea of new medical applications and recognize that, hey, if you're not already doing this kind of work like the current hematologist that you and your mom are seeing, how are you going to pick this needle out of that haystack?
so in our. Project we're using a smaller sample of patients to be able to test this project on. So obviously we would probably have to reach out and communicate with, medical offices or hematologist to advocate for our idea, and we would start with a smaller.
Sample of patients and then test it on them and stuff. And I feel like if we continue testing on them and if we work out the [00:14:00] flaws, we see what we can improve on. I believe that if our system is. Good enough if it actually improves the patient and also the physician, that we would be able to advocate it towards other medical, practices, other hospitals, and we would have those hematologists or OB-GYNs to back us up as well.
Sure. So Sophia, it sounds like you guys are really proposing kind of a clinical trial of this model. Yeah. And I agree with everything Tahi said about the small group, like the advisory group to start off with. and that's what the study with AVA did with PCOS patients. I think it was 42 women who piloted the program first.
Mm-hmm. And I think we would definitely need to be in conjunction with primary care to start off with. And so when these patients come in, who. Maybe don't know about the condition and their primary care doctor is saying, okay, we need to refer you to a hematologist.
Here's your referral. And also here's this educational [00:15:00] handout on this new tool that they're using for people who may or may not have this illness. So people can find out about it that way. And I think from there, People will talk and I mean things on the internet go pretty far. So I think from there it could be good.
And then from there we can see what we can do with hematologists as well. Sure. It also sounds like this might be a way of enabling a little bit more of a stay in play approach in primary care, where if the primary care physicians feel like. I'm a little more comfortable now with this support tool.
Mm-hmm. That I maybe don't need to refer to a hematologist. 'cause as you probably know, that puts two or three or four months extra waiting time onto getting to your diagnosis and getting to your treatment. You know, if the primary care configure this out, realize that you can't tolerate oral iron and refer you a week or two later to go get an iron infusion.
It's a lot faster. Right. How are you gonna know if it's working? I [00:16:00] think the general consensus that the study we used came to was they interviewed all of the participants after they first rolled out the piloting program and they did interviews and they based their metrics on whether or not the tool was effective or not based on the knowledge that those patients had about their health.
So there was two in particular that we talked about, and what they were both in short saying was that they felt more in control of their body and their condition because mm-hmm. Like the educational portion of the system allowed them. To have that kind of knowledge and have access to that kind of knowledge and actually gave it to them because I'm sure you know how it is, you're phishing through like a sea of research that's from the nineties and now it's 2026.
Mm-hmm. So this tool would have the most recent publications on like iron deficiency, anemia, and it would be easier access and more patient friendly for people who may not like, have the ability to fish through all of those studies, [00:17:00] don't have the time to fish through all those studies and weed them out.
Mm-hmm. You know? And to your point, I had a recent, update from a colleague who's recently retired and very knowledgeable in the general medicine world that, shared that something like a third of women may actually be iron deficient and most of them don't realize it, in the hands of somebody like that who's like, why am I dragging around so badly?
This might be the thing that gets them to ask the right question that gets them to care. So I'm excited to see where stuff like this goes. This is one of these uses that makes me excited about AI as opposed to all the ways that it scares me.
I think this is a really helpful way of turning the big idea of, you know, listening to people into something really concrete. Like how do we listen? Well, we listen by sharing ideas across a. Larger group of people and learning from each other. So thank you both so much for coming on the podcast.
I look forward to great things from both of you in the future. Thank you. Thank you.
Part 2
[00:00:00] All right, good evening. We're back with a couple of my students from the course. I wanna introduce Ryan Ross and Trevor Staub, who are gonna talk to us a little bit about their project. But first I wanna hear a little bit about who these guys are. So Ryan, introduce yourself to the listeners please.
Yeah, my name is Ryan. I'm a senior at Pitt. I'm majoring in neuroscience and after I graduate, This coming semester, I'll be applying to med school for the 2026 cycle. Okay. Any idea where you wanna end up? Say pit? Yeah, I guess pit wherever it takes me really. But pit would be great. Yeah. Sorry. I'm incredibly loyal to the school having gotten pretty much all of my higher education there,It is what it is. Trevor, tell us about yourself. It's gonna sound strikingly similar, but I'm also a senior at Pitt, majoring in neuroscience and hoping to apply to medical school. Not this cycle, but the next cycle. Very cool. Okay, so well for you guys in the fall of 27, maybe coming through the rotations.
So you guys did a really [00:01:00] fascinating project that your classmates loved and that I really thought was, awesome as well. You talked about the idea of doing narrative pain consults, so tell us a little bit about what that is. Yeah,, it started with the interview that we did for the project. I interviewed, my friend who experienced, an injury when he was in the later years of high school, and it caused him severe back pain, which ended up being chronic, as he went through.
This experience with the healthcare system, seeing different doctors and all that stuff, he realized that he wasn't really getting his questions answered and, he also wasn't getting the treatment that he desired. we came up with this narrative pain consults, which is basically a 15 to 20 minute time, that's taken out, specifically for the patient to give their story.
So that they could be a little bit better understood. And, just so that they would have the opportunity to have that uninterrupted time to tell their story. Got it. So Trevor, if you could explain a little bit what was missing from these [00:02:00] encounters that Ryan's friend had before with the doctors that he actually saw?
that would be added back in by having a consult like this. It was mainly our goal was to bridge the gap betweenThe narrative of the patient in question. And then the interpretation of the physician. Because a lot of times, even though a patient might be feeling immense pain, if there isn't anything clinically relevant or any sort of test that's coming back, that would be indicative of a certain treatment.
They might be more likely to dismiss the way that they're actually feeling in that way. There's a large disconnect between what the patient's actually experiencing and how the treatment's unfolding. So I like the word you used of dismiss because that's something that we talked about a lot in the course.
A lot of doctors will use a phrase in their notes, pain out of proportion to exam. Like, if I can't see the thing that's making you hurt, [00:03:00] then it must not exist. you're having too much pain for the situation you're in. what was going on with this guy that was. I remember you saying in class that he was really being pretty severely affected in his day-to-day life by what was going on.
So that was part of the reason that get the story, the narrative, rather than just look at the physical exam and the clinical findings, what was going on in his life. Yeah. he basically, within,A couple week period from when the, injury first started to when it got a little bit worse.
He went from being an athlete who was playing high school sports, doing all the normal things that you would expect,a healthy 17, 18-year-old kid to be doing to not being able to do any of that stuff. Even like walking around, was hurting him. I remember he would even walk to classes with a little pillow that he held and he had to put it on the back of his chair to give him like lower back support.
And it was just things that, he never really expected to happen, maybe super later in life, but definitely not at a young age of, like 17 years old. So these were really things that were affecting him a lot, [00:04:00] and not just affecting his life, but also, affecting his mental health as well, because he wasn't able to do all the things that he loved to do.
Yeah. Ryan, you're describing something that I see a lot in my patients that are nearing retirement or. have a work injury or something like that. But this is happening to somebody who's younger than you guys are now. a, not even having yet reached the peak of his career as an athlete.
And there's a certain, loss of self, if I'm understanding you correctly, like the identity of being an athlete is gone. Sorry. Yeah, definitely. and that's also with, specifically with these narrative pain consults that we came up with. There,are four people who are under 21 years of age who are experiencing chronic pain.
and Trevor could talk a little bit more about it, but, one of the main reasons we did that was because a lot of time the physicians are biased to think that these young people don't really know what they're experiencing or don't have a full grasp of, the pain. And they could push 'em to the sides, often.
Yeah. okay.
So Trevor, you've been past the baton. tell [00:05:00] us more about this. Narrative pain consult. Yeah. So our interviewee, like Ryan mentioned, he wasn't expecting to experience chronic pain at the level that he was experiencing at such a young age.
And I'm guessing that the physicians that were treating him were probably also not expecting for someone that young to be experiencing what he was experiencing. and it goes back to what I was previously mentioning with that disconnect. Even though, our interviewee was going through something that was completely uprooting his sense of identity, his sense of self, as an athlete, especially in high school, it can kind of become all encompassing. it's, you're going to practice after school, maybe even before school. You are doing weight lifting, you doing. Club to practice even after that maybe. and it seems like that's your entire life and in a lot of ways it is. And for that to be taken away all at once, it's [00:06:00] very hard to learn to live with that.
And then when you're, and that's paired with being dismissed and how the feeling that your feelings aren't justified. It could be very disheartening and Sure, yeah. I can see somebody in that situation saying like, why would I be faking this thing that has left me with, nothing concrete to fill my time with, with nothing constructive to do.
Like, why would I choose that life for myself? yeah, I completely understand the. frustration at the dismissal. I'm interested in why focus this specifically on pediatric patients? Under 21, chronic pain is a widespread problem, that usually affects adults. so what was the motivation for keeping it in that under 21 age group?
I think part of it was the fact that, We're around that age. So this is [00:07:00] something that's directly applicable to us. But also the fact that kinda like I said earlier, a lot of times young people who have chronic pain are overlooked. and we actually found in our research that, approximately one in five young people are dealing with some sort of chronic pain.
And that's the number that I think a lot of people wouldn't expect. so we thought that this specific younger demographic was really important. And, should be focused on, in these narrative pain consults. And another big thing that we noticed was that, or I guess that we thought about was that the experiences that you have with healthcare providers at a young age are things that will go on to shape your view of healthcare for the rest of your life.
so if something happens to you in high school and you have a really bad experience, you might go through the rest of your life saying, oh, I don't wanna go to the doctor. I don't think they're gonna be able to help me. but if these young people did have a good experience, then it could be the exact opposite.
Yeah. You're talking about a bunch of really important things. The first of which, and I fell into the trap just now, is expecting the typical pattern to [00:08:00] be true a hundred percent of the time. And you're saying typical patterns True. 80% of the time, but 20% is a lot of people. And I think the situation Trevor described of.
The intensity of being a high school athlete where there's practice at both ends of the day and practice out outside the regular season, may be part of the reason why that's happening. a lot of athletes that get injured for the first time when they're preteens, especially in sports like gymnastics and skating and,a lot of those sports where there's.
Intense training before people's bodies are mature. So you can make an excellent point that this is an overlooked group, but a big overlooked group. and first impressions are hugely important as well. Okay, so I'm on board, but I bet you guys can hear already the voices of maybe some of this guy's doctors saying things like, who's gonna do that?
That takes so much time. I already don't have enough time in my day for all my patients. It's such a huge [00:09:00] burden. It's a waste of my time. It's not gonna actually make any difference in the outcome. Or even it's too expensive. plus people who actually don't believe that he's in pain. But we're gonna leave those people outta the side because I feel like they're probably hopeless
what's your response to somebody who gives you that kind of pushback? 'cause it will certainly come if you propose something like this, right? ' I think it's more so the. Focusing on maybe even if it's not 15 or 20 minutes, but even starting out smaller and saying, Hey, if there's five minutes of uninterrupted time for a patient experiencing chronic pain, who Also is under 21 years of age, to just be able to tell their story in a narrative way with obviously brief clarifying questions and interspersed in between and seeing.
How does that affect care? How does, or how does that even just affect subjectively, how the patient feels about the interaction with the provider and then maybe [00:10:00] scaling it, expanding it to Okay, we're, we can maybe train some of the medical assistants or some of the nurses to be able to do this and not dig into the physician's time, but very limited physician's time with their patients.
Yeah. Not to quiz you guys in the middle of an interview, but you remember how long it takes. If you let somebody speak uninterrupted about their problem, how long it takes before they'll basically be finished and stop talking. I don't remember. It was a long time. It was a long time. No, it actually wasn't.
It was short before physicians started interrupted. So before, but if you let them go uninterrupted, it's about two minutes. Yeah, Somebody can easily tell a story like that. And we even talked about the technique of practicing telling a story in four sentences and you get pretty good at it.
And then. The clinician can go back and say, oh, you used this really interesting word there, expand. Tell me more about that. And however much time they feel like they have to expand on certain things. But yeah, I love that idea of let's forget about the 20 minutes. Let's do five minutes. An [00:11:00] orthopedic visit might be 15 minutes. You give somebody five minutes to tell their story. You might only have two or three questions left that you have to ask them when they're done, if you let them be uninterrupted and then you've got 10 minutes to do your physical exam. And. Talk about the plan, make sure that they're okay with it and send 'em off to get their x-rays.
I think that sounds like a great idea. the problem is, not everybody is savvy like you guys are to be able to figure this stuff out. What do you say to someone if you are the clinician, to prompt somebody who doesn't know what to ask for or, if you're somebody listening to this, like, how do I get myself heard because nobody's listening.
How do you start when somebody doesn't know what questions to ask, if, whether you're a patient going to a doctor who doesn't know what questions to ask, or a doctor who's talking to a patient that doesn't know how to advocate for themselves. I would say from the physician's perspective, the interviewing, whether it's the clarifying [00:12:00] questions during the five minute or If we scale and expand at 15 to 20 minute. Open ended questions that aren't just inviting a one word answer, but allowing for the narrative to flow continuously and also beyond just language for just, are you facing the patient, right? Are you making eye contact? Are you the most you in that moment? Other things, typing on the computer, even if that is facing them, but giving them for five minutes or even two minutes, your undivided attention and actively listening to everything that they're saying.
And like you mentioned, maybe that prevent, that decreases the amount of time that you need to ask the rest of your questions in that use that precious timeline. So
if you prioritize the five minutes or 10 to 15 minutes With [00:13:00] the patient and you give them your undivided attention You can actually get a lot from that. and Something that can not only be valuable for the physician in terms of how they listen, but also very validating for the patient. 'cause they actually feel like they're being seen and heard. And you guys remember, one of the textbooks that we used besides the one that I wrote was, compassion Ons or Compassion Nos, depending on whether you think it's economics or genomics of compassion.
but those guys talk about even a 42nd concrete compassionate behavior in a visit gives people the impression that someone cares about them and. Like people going in and your case is really relevant because it decreases the amount of pain medication people need after a surgery, right? So even 40 seconds of, Hey, I heard, the medical assistant that checked you in said you had, [00:14:00] not been able to play your sport since you got injured.
That really stinks. I'm sorry that happened. I hope we can help you. And if that's all you do and then you launch into the regular thing, think, oh, this doctor's on my side. And that might actually directly affect your perception of pain. I don't know whether you guys got that impression from the reading that you did or not.
Yeah, I I think we definitely did get that impression. And, when you said that about the. having the feeling that the doctor is on your side that Reminded me of a specific part in our interview when our interviewee actually said that he felt as if him and the doctors were on opposing sides and they were almost like fighting against each other.
so yeah, I think if you could implement something like this and allow the patient to feel as though they're working on a team to get to a, Shared goal, it would make, it would definitely make a big difference. Yeah. I love that, that quote that you brought in from the interviewee.
And I, I think that maybe if you run into, if you have the opportunity to implement this, at some point you run into a cynical doctor, like the hypothetical one I [00:15:00] mentioned. That's the way to sell it, right? you want to be on the same team with your patients, give them 40 seconds, or give them three minutes at the beginning of the visit so that they can tell their story the way they want to tell it, and then let them know that you're on their side.
And you've spent three minutes and you've bought yourself their loyalty so that you can do the work that you know you need to do to get them better. And then when you see paying out of proportion to exam, you might also be able to think back to, oh yeah, this guy just had his career. That was gonna be his ticket to a college scholarship and a, potentially D one athletic career and maybe even a professional career like it's gone.
So of course it hurts, right? 'cause he has nothing else to focus on but his back pain. So I think that might be your sales pitch if you're ever looking to put this into effect five or 10 years from now when you guys are Ryan, Ross and Trevor Sta. MDs instead of, pit undergrads.
Thank you so much for sharing the ideas behind the project. I can [00:16:00] see why your classmates love this one so much. thanks for your time this evening. Any last words for the listeners? No. yeah, thank you for having us on. It was great to be able to, explain our idea and it's something that we definitely hope we could, make real, in the future.
Great. Okay. I'll talk to you guys soon and Trevor, I'll see you Monday night. Yes. Looking forward to it. Okay.
Part 3
[00:00:00] All right, we're back. And for this, part of the show, I wanna welcome two more of my students, Shruti Chandra Shekar, and Guillermo Cruz. And they're gonna talk to us a little bit about their project, about pediatric simulated patients. But before that, I obviously want to know a little bit about them.
And Shruti, could you introduce yourself to the folks listening please? my name is Ti, I'm a freshman at the University of Pittsburgh and yeah. Okay. Anything else about, about the future or what you do outside? I'm a molecular bio major and I'm on a pre-med track. Yeah. Okay, got it. And you're from where?
uh, New Jersey. Okay. Like Central Jersey. Yeah. All right. And Guillermo Cruz from the other side of the state line in Allentown, pa, tell us a little bit about yourself. Hi, my name is Guillermo. I'm a public health major on the pre track as well, and I'm just excited to be here.
Thanks. Okay, great. as I mentioned, you guys did a project about pediatric simulated patients or SPS for [00:01:00] short. tell me a little bit more about that.
yeah,we decided standardized pediatric patients, throughout our research we decided to tackle because, our patient. who we discussed in our project, faced unfortunately a very traumatic and negative experience, in the emergency room. And we felt that standardized pediatric patients and implementing those sessions into medical school curriculums and training could be a very helpful and insightful way to tackle that kind of issue and to prevent other children from experiencing that.
Gotcha. Sure. Clearly this was a younger person, not an adult that you were talking about what exactly happened with him. this was an interview that Guillerma did, but the person that he interviewed had, received experimental allergy injections that were not FDA approved, which resulted in a severe anaphylactic reaction, which ended up in her being admitted to the er, and a major issue that she had during her ER visit was feeling [00:02:00] overlooked and unheard by her.
Physician throughout the experience because of her age. And since the physician only addressed her parents when asking questions and not her, even though it was her that really went through the experience, she really did not feel that he valued her opinion as much and we just
wanted to fix that.And if I remember correctly, Guillermo, this was somebody who was not a small child, but like early to mid adolescence, So old enough to speak up for herself. I believe she was Exactly, yeah. She was nine years old, I believe. Oh, okay. When it happened. And so that's a tricky age, right?
Because on the one hand you look like a small child. On the other hand, you've got opinions. I've known fourth graders in my lifetime. I've parented three of them. They definitely have opinions. Tell us what your intervention does. a lot of the folks listening may not be familiar with the idea of an sp of a simulated patient.
So what is that all about ? Yeah, so I can explain that. standardized patients are essentially, people who are trained and hired [00:03:00] to, enact like medical scenarios and as a test for medical students to interact with and to practice like. Different, communicative skills like diagnosis or just simply interacting and talking with the patient.
these standardized patients act as conduits for these medical students to practice those kinds of skills and. During our research, we found that while standardized patient programs are typically popular, standardized pediatric programs are a new emerging field.
And that is currently being explored, across like many different, curriculums right now due to that exposure and meeting with a child rather than an adult who might be able to communicate better with you. I got you. So what I'm hearing is that standardized patients are widespread, but most of the standardized patients that people interact with are adults.
What are some of the obstacles to being able to put something like this in play?
[00:04:00] I'm not yet asking the cynical question, like, why should we bother? But it sounds like it's been hard, if it's taken as long as I've been in medicine and we still haven't really gotten to the point where I have a lot of these , what's, what's preventing that from happening? something that we addressed in our paper was that, like child labor and exploitation laws, there was like a lot of things about the hours that they can work and if they're really like consenting to being a standardized patient, but there are laws that are in place to help that.
It is just like it's definitely you can work around it, but I think that was something that like affected if it was really gonna be implemented because the laws for children were a lot more. constricted. I got you. So I probably shouldn't drag my 14-year-old into the med school and just make him sit there pretending to be a patient for six hours.
That might be illegal. Yeah, that was definitely a concern. I'm glad I didn't go that direction. seriously though, So I'm interested in what kind of skills you feel like people are gonna learn from having this opportunity with a child or a, [00:05:00] an adolescent actor rather than an adult actor.
What's different about that interaction Maybe than,the interactions that they learn from an adult actor. Yeah. So one, oh, if you got it. You go. Alright, perfect. So during our research, we found, went directly, from like the original studies pertaining to the, diagram the, of the life world versus the voice of medicine.
And we found that during those studies, They specifically reported that while all the studies performed were of course like accessible, and they of course created that diagram. They mainly were with adults. They were mainly with people who could speak to the doctors properly. They were mainly with people who could speak the same language.
They were mainly like just people that could share that domain and could actually properly communicate. Mm-hmm. With a child, we found that. That's not always going to [00:06:00] be the case. That child isn't always going to be able to communicate as properly or as professionally with you as another adult may.
So we wanted, ultimately, in implementing pediatric patients, we found it would increase the, compassion and understanding and Allow more open-mindedness. For medical students and for people participating in this so that they can breach maybe those additional barriers and accommodating to the child and lowering themselves to that level rather than not having to move at all because you have another adult standing in front of you that can understand everything you're saying.
So talking to the parent is the path of least resistance, but that doesn't make it the most effective way of providing care. It's almost like you're saying that. Being a child or an adolescent is like you're from a different culture or speaking a different language, you could absolutely
say that one thing that we also discussed in our paper is the concept of linguistic [00:07:00] relativity, where essentially a person's native language and their thoughts are determined by their culture, by their language, by how they like talk to other people. And we. Concurred that, medical students and doctors after going through the process of medical school and residency, that their way of speaking in this professionalism and like with these, medical terminology, that they might not be able to necessarily interact as properly with patients, especially pediatric patients.
And even in our scenario specifically, Our patients in our story had her own things to say. Like she knew exactly when she began the anaphylactic shock. She knew like the timing of everything. She knew what was happening to her. She just didn't have the chance to communicate it because the doctor chose not to.
I gotcha. and that's. That's interesting in particular because [00:08:00] you talked about the linguistic relativity for med students, like they have that problem with grownup non-medical people. I feel like the same thing happens to people as they're entering adulthood. Like you go to college or you go get your trade and you go out into the work world and different things become important to you, and pretty soon it becomes hard to talk to your kids and hard to remember what it was like to be one, because you've got different language about the world you live in.
Yeah, that's a great concept to take with us. I'm reminded of something that occurred to me when I was doing one of the other interviews. They were talking about a, an adolescent, an older adolescent, 17-year-old who had a painful injury. And I remember learning as a pediatric resident that there are different ways that children of different ages will express the exact same pain, right?
So a child with a urinary tract infection who's like a toddler. Won't say that it hurts, and it won't even be clear that they're having a problem with their urinary tract. They'll just have a fever [00:09:00] and they'll feel sick, and the I don't feel good, whatever. When they're about four, they'll start to say, my belly hurts, and they'll point to their belly button.
Now, that's not where we pee from, but that's where it is. Only after about seven years old will a child who's ha, who has a urinary tract infection say, yeah, it hurts down here, and point to where their bladder is or say it hurts when I pee. Any age younger than that. And that's exactly it. You have to know how to translate that, that language into what you're actually looking for.
and that's kids who speak the same language, the same spoken language as the doctor, let alone, kids from a different culture. Okay. So that's great. We all agree on that being a really valuable thing. But truth, there are gonna be people who say, I don't need this. What kind of challenges did you guys anticipate to implementing this kind of program, and what would you say in response to getting those challenges?
there was things that came up that was like, parents are a very big part of trying, go over like work around the linguistic relatively, like the language barrier [00:10:00] between the kids and the doctor. And that they're gonna be in the room. So something that we, they came up with was like.
Having the child's parents act as a dyad to help With the, the parent and like patient, the patient and doctor interaction and having them as a di dyad would help the medical student in our, our sessions. And it would just help the transition with speaking, we'd have the medical student speak with the child alone and then speak with the dyad just so the child can.
convey what they wanted to say and then also have the parent like fill in the blanks for the medical student just in case that they wouldn't really understand what's going on. Okay. one of the big complaints in medical education is the lack of time. We're already talking about, like we're trying to cram so much stuff into four years of medical school and we're already looking at compressing.
Like at pitt, at the medical school at Define Institution of Undergraduate learning that you go to, they're, squeezing [00:11:00] the whole preclinical curriculum into 18 months. Now. It's not even two full years to give more time for people to go out in the clinic. Where do you see fitting something like this in to that kind of packed in, no room at the end kind of curriculum?
I can answer that question. again, I'm referring back to our research. we did see one medical school, I forget the exact name of it to be honest with you, but one fellow medical school began those sessions actually From, I believe like their first year.
Like they implemented them their very first year to prioritize that compassion and understanding and actually like increase that understanding of the patients. So that they are more prepared for those interactions, not just going into their third or fourth year, but also just in general.
And we, we find that could be very effective in tackling that same issue that may be present in Pittsburgh as well. So making sure, for example, like in the patient interviewing class that I took when I was a first year med student, that there are a [00:12:00] couple of kids in the mix because that was one of the very first classes I took.
That makes a lot of sense. I remember also that you guys said that there was a particular advantage to Pittsburgh maybe being a place to. To pioneer this or at least adopt early, what were some of the reasons for that? Yeah. the University of Pittsburgh already has an SP program that has been very successful.
So I, like, we thought that just having, like the pediatric patients also being put into the mix would be easy to implement and integrate through that program and it would just be better for the students . So it's an expansion rather than a new launch. Yeah. I, you also said something about the, uh.
Under the radar, but very high level Pittsburgh film industry now. yes, we did. we recognized that Pittsburgh, because of its unique environment, because of it's booming really, their film industry and acting industry. And a lot of film directors and actors actually love the city of Pittsburgh.
[00:13:00] Because of a number of reasons. It's both a financial, issue because apparently, it's less expensive to film movies in picture way cheaper than New York or Los Angeles to film and yeah, much cheaper. So it's a very desirable area, for upcoming actors, for upcoming directors, to film their movies, especially with, medical shows that we have already, like the pit
And recognizing, that further surrounding the area, there are a lot of child acting programs. And ultimately we find that this opportunity to act as maybe a standardized pediatric patient could be an interesting opportunity for those children as well.
And for in general, those programs because of the environment that we already have in Pittsburgh. So it's just capitalizing on that. That's a tremendous idea. I love it. okay, so we talked a little bit about what some of the cynicism would be like. For example, there's no time to do this. and I can see people also saying [00:14:00] that I don't need this.
What do you say to somebody? How do you broach the subject with somebody who doesn't realize that they're missing these kinds of skills? Like maybe to that ER doctor who I'm sure is a very skilled emergency physician, rapid diagnosis, moving people through to treatment, really getting to the next level.
I'm guessing that was probably a pediatric er that this person went to, because usually don't take kids who are having anaphylaxis to an adult er. So how do we help people recognize without insulting their. Very excellent skills that they do have. How do we help them recognize that maybe they don't talk to kids in quite the most inclusive way?
when doing our research , there was like a study we came across that was Like many doctors were not very comfortable with examining, diagnosing, and treating pediatric patients. And the findings of the study were that there was a general lack of comfort with managing pediatric patients.
So The, like the discomfort with physicians alone is an [00:15:00] issue. And I guess Parents could also like gauge their child's feelings. So if during an encounter the child is not feeling like comfortable or they feel like unheard or unseen, the parent can vouch for their kid and tell the physicians, if they're comfortable enough, like they can tell the physician, my kid can answer these questions,you can forward the question to them and not straight to me.
I feel actually advocate for more inclusion of their children. So that's one really good solution is since the adult is the one that's maybe got a little bit more of the clinician's ear, they can be the one to say, Hey, I'm not actually who you want to talk to. It's a great idea. Guiro, what about, what about you?
What do you think we can do to bring this to people's attention? emphasizing that point further, what Shahi just said, like that really nails it on the head. we found it in our research that,the discomfort increases with decreasing age in the patient.
So ultimately we can discuss with physicians that. Your [00:16:00] clinical skills, your medical skills are absolutely like valid. And you've done through a lot of training. However, we have patients like the ones in our story where even though figurative medically you might have done everything right and everything you could have done.
Mm-hmm. She still ended up feeling ignored, unheard, and emphasizing that. You could still do everything perfectly and yet, like medically, but not emotionally for the child can happen. Right? And that we can strive towards a future where that doesn't happen. Implementing these kinds of sessions and increasing that level of, understanding and compassion.
Yeah. For sure. And I, I think back to what you were saying before about linguistic relativity. My wife's a special ed teacher and she talks all the time about how to scan something for reading level. is this text appropriate for a third grader to read? Is it appropriate for a sixth grader?
And the same thing is true of the spoken language that we use, right? What's the right [00:17:00] tone and emotional, temperature. Word choice to use when you're talking to a 15-year-old versus when you're talking to a 5-year-old. And I think a lot of us might be comfortable with one age, but not all the ages.
and I gotta be honest, as the guy in my early fifties, if I have to talk to a 16-year-old, one thing that's gonna be running the back of my mind is I'm really worried this kid's gonna think I'm old and weird. Because that's just a thing that happens like teenagers, basically. anybody who's more than about five years older than them, they don't have time for, so there's that.
Also, we all get embarrassed, but we know that there's pediatricians who have that magic about them. They can walk into any room. Doesn't matter how old a kid is, they can immediately flip a switch and they're seven or they're 17. Or they're 45 and talking eye to eye with the parents and they can code switch immediately.
I look at this and think this is a great project to teach people code switching that don't already have that natural skill. [00:18:00] So thank you guys so much for doing this, and I wanna shout you out specifically because thanks to Guillermo's public health background, you guys actually put together a budget for this.
So I'm gonna let you leave on a high note and tell me, ' cause one of the cynical questions, right? How much is this gonna cost? So how much is this gonna cost, guys? Yes. I believe the exact price was $10,648 and 15 cents to do how much of this it would cost that much for what scope of this would be.
This would be, that would be the total cost for the start up year of it, of the program. So with that in line, meaning like one typical size med school class? Yeah. I believe we did a sample size of 10 standardized pediatric patients at first. Okay. And, of course, unfortunately due while we were finding our prices.
for different things. I tried to use as much as like pits, standardized patient program as much as possible. [00:19:00] However, a lot of it was hidden fees, so I had to go to other places. So it's very, that number may seem high, but the, advantages that you could see coming out of it is that one, it's its startup year, so It's typically going to get cheaper. And less expensive as the years go on, as it becomes more established and foundational, in like our program. And a lot of it was from averages from other schools. I do not know how Pitt would price, out, for example, a room that they would use for these sessions. I had to get that from somewhere else, like advertising.
I had to get from somewhere. I had to estimate, the one thing that we were able to use. Was how much they pay standardized patients, and we were able to, that was a big chunk of the cost. Sure. And true to you were, you were saying before,this is an established program, so you're folding these kids in, so the [00:20:00] rooms and the instructors and all of that stuff is already there.
You just need to snag a session or two out of the curriculum and say, instead of, this case we're gonna do. Maggie, who's seven years old and has a UTI, right? and that'll be your new standardized case. So I think there's room there. And to, from what I remember, the small groups are usually nine or 10 kids, so maybe instead nine or 10 students, and the class is about 140.
So maybe you're looking at 15 sps not 10, but. Okay. Sounds like a great ballpark. I'd love to see if this actually goes somewhere and I look forward to running into you guys down the road and seeing what happened. Thanks so much for being on the podcast. I appreciate your time. Thank you for having us.