Learning to Listen

By Nina Gulati, M27

I’ve been told that not many students come into their first year of medical school with a specific interest in rheumatology. On more than one occasion, I’ve had to explain to my friends (after clarifying for myself) what the field actually entails. However, I’ve always been fascinated by the complexities of autoimmunity and rheumatic diseases. This curiosity is what prompted me to reach out to Shanthini Kasturi, MD, MSc, during the fall of my first year of medical school.

After shadowing Dr. Kasturi in the clinic and learning about her extensive research in systemic lupus erythematosus (SLE), I was eager to work with her the following summer. Dr. Kasturi’s research focuses on addressing chronic fatigue in patients with SLE. Fatigue affects 90% of people diagnosed with SLE, and this experience is often unexplored or ignored by providers. Her previous research involved investigating the role that movement or exercise can play in improving fatigue, in addition to exploring the utility of mobile health apps specifically designed for lupus patients to track movement and set personal goals.

This summer was the launch of the REACH (Restore Energy, Activity Can HELP) Lupus Study, which was the focus of my summer research fellowship. This pilot study is looking at the role that peer coaches can play in encouraging movement in people with SLE. The program is twelve weeks long, during which participants set weekly movement goals on an app designed for the REACH program. Those in the intervention group meet weekly with their peer coach to discuss their progress.

Over the summer, I played a role in study coordination and data analysis. Some of my major responsibilities included outreach to potential participants, conducting weekly check-in calls with enrolled participants, and meetings with peer coaches to discuss their clients’ progress. In addition, I worked with my fellow Tufts student Zoë Gilbard, M25 to assess the use of motivational interviewing during peer coach/client meetings.

Looking back at this summer experience, I believe one quality that set Dr. Kasturi’s research apart from others was its emphasis on patient-reported outcomes and the patient experience. As a former bioethics and philosophy minor, I was drawn to this research because it placed patients’ voices at the center of care. I talked to participants about their work schedules, diets, vacations, and hobbies, and I listened to how each of these aspects of their lives affected fatigue and interacted with their overall lupus diagnosis. Although reviewing the quantitative aspects of a patient’s disease progression is essential in clinical practice, this research experience taught me that genuinely listening to a patient’s lived experience is just as important as tests like CBCs or imaging.

I thought I had a general understanding of what the field of rheumatology encompassed. But working in the REACH program with Dr. Kasturi taught me that rheumatology is more than just a scope of diseases; it’s a dynamic practice of active listening and centralizing patients’ lived experiences. I am very fortunate to have observed this through my summer research experience and hope to embody these values throughout my journey in medicine.

Nina Gulati is a second-year medical student at Tufts University School of Medicine. She is originally from Fort Myers, Florida and attended Georgetown University. At Tufts, she is the co-captain of the soccer team and the volunteer coordinator for Healthcare Alliance for the Homeless. Currently, she is interested in pursuing a residency in internal medicine and completing a fellowship in rheumatology or nephrology.