The modern demands of patient care can weaken the connection between clinical encounters and scientific inquiry that often leads to innovation. The kind of curiosity that led a young doctor to develop the first dialysis machine based on a patient case, for example, can be lost to additional administrative demands and shorter patient lengths of stay. To reinvigorate this vital cycle of insight and innovation, the Department of Medicine at Massachusetts General Hospital (MGH) launched the Pathways Service.
The service matches residents with complex cases, giving them two weeks to review each case’s extreme or unusual disease symptoms, meet with the patient and family members, develop a hypothesis, and identify research and clinical steps that could help resolve unanswered questions. The residents present their cases to their peers and cross-disciplinary volunteer faculty, who debate the information presented and agree upon additional clinical and laboratory investigations to follow.
The program, developed by former residents Victor Fedorov, MD, PhD, and Lauren Zeitels, MD, PhD—who tragically lost their lives in an avalanche in March 2017—has helped residents learn to take a necessary step back when faced with complexity.
“I think it’s the power of the individual case driving the question, but also having the time to dig in and recognize how little we understand about disease progression right now,” notes Katrina Armstrong, MD, Chief of the Department of Medicine, MGH. “And to identify the tools available to address the scientific questions that arise in caring for patients with unusual or unexpected disease states.”
The cases covered by the Pathways Service to date have looked at wide-ranging questions in medicine, from what causes thickening of the heart wall to why anti-inflammatory drugs are sometimes ineffective. A recent case revealed that granulomas, not inflammatory bowel disease, were the cause of one patient’s symptoms—leading a resident on a new career trajectory centered around granulomas’ underlying cause.
“What was most exciting to us is that it changed the course of what that resident thought about studying and doing for the rest of her career, recognizing that we don’t understand granulomas at all,” says Dr. Armstrong. Building a workforce dedicated to digging deeper on such questions is precisely the aim of the program, she adds.
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