Narrative reflection written by Tiernon Riesenmy – Clinical Experience for Engineers – July 2024

We had just said goodbye to the first patient from Dr. Paul Beach’s autonomic testing. I was observing Dr. Beach, a technician, and a visiting medical student perform autonomic testing for the morning. Everything so far went off without a hitch. Dr. Beach subjected the patient to the Valsalva maneuver, which had the patient forcefully blow into a mouthpiece. The test checks the part of the autonomic system that accounts for changes in blood being returned to the heart. After obtaining sufficient blood pressure and heart rate information, he then performs the tilt table test on the patient. The test looks for signs of lightheadedness and fainting which may occur from poor flow of blood to the brain while standing. Neither test elicited any visible issue in the patient, although Dr. Beach did catch some abnormalities in the heart rate and blood pressure data being collected. By all means, though, I had witnessed the average autonomic testing appointment. Our experience with the second patient was a complete shock in comparison. It reminded me of a growing concern of physicians that I learned from one of the Department of Medicine’s grand rounds.

In the first week of the Clinical Experience for Engineers course, I watched the Department of Medicine’s grand rounds titled “How AI Can Promote Accuracy and Empathy in Medicine”. The speaker discussed a growing trend in the tradeoff between a doctor’s time spent with their patient and their time spent behind a computer. I had noticed this myself as I’d have appointments where it felt as though the doctor was rather talking to their monitor than addressing me. The grand rounds had continued with an exploration of how artificial intelligence (AI) may mitigate the tedium so that physicians spend more time with their patients. As an engineer, I had not considered that the main benefit of improving the technology at a doctor’s disposal would be more patient interaction. I would come to see why this was the case as I began my clinical observations. The autonomic testing observation, in particular, highlighted how important it is to free doctors from being glued to their computer monitors.

Dr. Beach is an incredibly personable physician. I had noticed this in our email interactions as he was quick to respond and thorough in his response to my inquiries the day before my attendance. Most importantly, Dr. Beach is kind. I saw the extent of his kindness during our experience with the second patient in his autonomic testing observation. The patient was an unusual case. She came in explaining that she could not put forth any effort without fainting and suffering muscle spasms. It had completely prevented her from performing her hobbies and from living her life. She came to Dr. Beach based on recommendation from doctors that couldn’t give her clear answers.

After the preliminary setup with the electrocardiogram (ECG) and blood pressure recording devices, Dr. Beach and the technician strapped the patient to the exam table. They were to start with the Valsalva maneuver. The patient provided three deep breaths into the mouthpiece before fainting. It was a concerning sight. She had completely gone limp, but Dr. Beach was quick to come to her side to make attempts to bring her back to consciousness. The patient came to consciousness after a moment before involuntarily spasming. Tears then flooded her eyes. She apologized for passing out during the test. Dr. Beach with such tenderness placed a hand on her and told her that none of what happened was her fault. The visiting medical student in attendance, too, reassured her by placing a hand on her shoulder.

Both the patient and Dr. Beach were motivated to finish the testing, as otherwise the visit would be for nothing. The patient blew into the mouthpiece but again fainted. We then saw a repetition of what had happened just moments prior. Dr. Beach made the executive decision not to continue with the Valsalva maneuver. Next, they prepared the patient for the tilt table test.

The tilt table test went as expected based on what we had just seen. Each time Dr. Beach tilted the table upwards the patient fainted and spasmed. She was devastated. She could not even undergo these tests without experiencing what had been inhibiting her everyday life. Dr. Beach and the medical student were quick to calm and reassure her. Dr. Beach never once exhibited anything less than compassion. He didn’t seem remotely frustrated, but rather concerned for the patient’s well-being. The same could be said for the medical student. I cannot imagine how the patient’s experience could have been if Dr. Beach had spent all his time simply staring at a screen. While it was important for him to monitor the data being recorded, his attention was certainly centered around the patient. Else, he would not have noticed the patient passing out during testing. I could tell the patient felt alone in her suffering. I hope that Dr. Beach’s care during her visit made her feel less so.

The patient left with further questions regarding her affliction. Dr. Beach had some suspicions but admitted he would have to confer with colleagues about what he had witnessed that day. The patient left with gratefulness towards both Dr. Beach and the medical student for their compassion. The experience made me reflect on the motivations behind my intended research. As a machine learning engineer, I needed to ask myself what I could do to allow a physician such as Dr. Beach to allot more focus to their patient.  Prior to that morning, I had simply been motivated in researching the underlying mechanisms in neurodegenerative diseases. I had considered more accurate diagnostic tools to be my most important contribution. Dr. Beach showed me, rather, that the patient benefits most when provided more human interaction with their doctor. Endowing the physician with more opportunities to communicate with their patient directly may be the best contribution of an engineer. If the doctor can spend just one more minute with their focus on the patient, then they can use the most effective tool at their disposal: tenderness.