Easy conversation and laughter filled Cathy Variano's Lansing home Thursday while she explained her health-care coverage as a patient with chronic illness.
Variano, 55, laughed about the attractiveness of her doctors as a first priority while second-year medical students Lisa Aenlle-Matusz and Tom Bryson jotted down notes.
"I don't make anything easy for them," she said, laughing.
Aenlle-Matusz and Bryson have been learning the patient's perspective from Variano for more than a year as part of the Longitudinal Patient Centered Experience program in MSU's College of Human Medicine.
The goal of the patient-oriented approach is to enhance the students' communication skills and understanding of chronic illness.
Chronic illnesses, such as heart disease and diabetes, are long-term and impact a person's life.
"We have strong courses, and our grads are particularly good, but you can't be too good," said Jane Turner, director of the Longitudinal Patient Centered Experience and the college's assistant dean for preclinical curriculum. "If you ask about experiences with doctors, you have many complaints about communication."
On Thursday, in their seventh of eight visits, Aenlle-Matusz and Bryson learned Variano is pleased with her health-care coverage. She receives TRICARE medical coverage because her husband, Brian Variano, is a retired member of the U.S. Navy.
The students will compile the information from the interview into a paper and will discuss aspects of their case with a small group of medical students. They said her lack of complaints will add another unique aspect to what they bring to the table.
"She has such a complex set of issues; she's a special case," Bryson said. "I remember coming out of the first meeting, and that was not what we were expecting."
Variano's health issues are different from most chronic-illness patients in the program. She received radiation treatment as a six-week-old infant to remove a tumor from her right cheek.
The procedure was done before the negative effects of radiation were known, Variano said, and all of her health problems go back to that treatment.
"It's the gift that keeps on giving," she said.
Variano has undergone multiple reconstructive surgeries, a hysterectomy, gall-bladder removal and has survived thyroid cancer twice. She went public with her story in 1994.
Aenlle-Matusz and Bryson have learned the history of her medical problems and the difficulties they have caused in her life. The students say they commend her turning a mistrust of the medical profession into a positive effort.
"It's really interesting to hear her take on it," Aenlle-Matusz said. "She's her own health advocate, and you really have to be these days with changing health-care coverage and coordinate your own care."
Variano has a no-holds-barred approach to having a comfortable relationship with each of her doctors. She regularly sees a plastic surgeon and orthopedic and family-practice doctors.
"People who gripe about their medical care aren't doing anything about it," she said. "If you don't take a proactive effort for health care, you deserve to get the heath care you get."
Both Aenlle-Matusz and Bryson said they were nervous to first engage in the program, but Variano's eagerness to help them enhance their communication skills has made the experience worthwhile.
"It's closer interaction and I'm not constricted by time, and I think I'm more open to ideas because I'm just starting out," Aenlle-Matusz said.
The Longitudinal Patient Centered Experience program assigns pairs of students, usually one male and one female at the same stage in their academic careers, to a patient for his or her perspective. The visit topics coincide with college courses, such as the Social Context of Clinical Decisions classes in the students' second year.
Leonard Fleck, a professor in MSU's Center for Ethics and Humanities who helped develop the program, said medical students need more patient contact in the early years of medical school.
"It occurred to me our students don't see the world from a patient's point of view at all," Fleck said. "I thought that we ought to give our students an opportunity to make multiple visits with patients to better appreciate how (chronic illness) affects their lives."
Fleck said communication skills are targeted for improvement as well as students' understanding of classroom studies.
"Some have to get better at asking what I call 'probing questions' and following leads a bit further," he said. "For most, it's a positive educational experience."
Through the program, both students and patients learn how the other approaches a situation. Variano said she has enjoyed working with Aenlle-Matusz and Bryson so much she has signed on again to help new medical students hone their communication skills.
"I did this so I can help them understand books give you guidelines, but you have to listen to the patient because you live in your body," Variano said.
Meghan Gilbert can be reached at gilbe109@msu.edu.
