The first day of my internal medicine clerkship rotation came with more than one learning curve. Before I set foot inside the VA, I was filled with dread at the prospect of wrangling my way through the VA’s medical records system, known as the Computerized Patient Record System (CPRS). Compared to the robust functionality of EHRs like Epic that I had grown accustomed to using, CPRS was outdated and clunky, a relic from another era of medicine. Its rudimentary search function seemed almost intentionally designed to test the limits of my patience. As one classmate had put it, CPRS was less a tool and more a rite of passage to working at the VA.
All the forewarning could not have prepared me for the chaos of my first day. I spent hours squinting at the tiny serif font of the CPRS interface, peppering my residents with questions about the simplest tasks. I had imagined medicine as a world defined by cutting-edge technology and complex diagnoses. Instead, CPRS forced me to slow down and approach medicine with a perspective that relied upon humble technology and slow deliberation.
Mr. R, my first patient, taught me this almost immediately. He was a soft-spoken gentleman in his 70s admitted for acute hypoxic respiratory failure. He had been hospitalized multiple times in the past year for asthma exacerbations, likely triggered by a roof leak and mold exposure at home. As I pieced together his story, CPRS became a window into his life. The limited interface compelled me to sift through an amalgam of ED notes, inpatient summaries, and pulmonology visits. Even more importantly, it required that I return to his bedside to understand his story.
As I learned about Mr. R, I began to appreciate the simplicity of CPRS and its archival-like quality. In contrast, Epic was filled with smartphrases, an integrated clinical handoff tool (the VA equivalent was a simple Word document that we fondly referred to as the “fakealign”), and endless customizability. CPRS stood in stark opposition, a humble, pared down record-keeping system. As my frustration began to dissipate, I grew to appreciate the technology’s quietness. In place of automatically populated outside hospital records, CPRS required that I sit with my patients, listen closely, and rely on their retellings. Unexpectedly, CPRS invited me to look beyond health records as the primary source of information gathering, and instead return to the patient as the narrator of their care.
Over the course of the month, I discovered a quiet humility to working at the VA that extended beyond CPRS. In contrast to the complexity of quaternary care I witnessed on other rotations at my academic institution’s primary site, the VA represented a return to the foundations of medicine. Many of the patients I cared for presented with the “bread and butter of medicine,” including heart failure, COPD, and diabetes. Their problem lists were often shorter, and their care was less fragmented across multiple subspecialty services. As an early-stage trainee, this simplicity offered an environment conducive to sitting with my patients as I learned the pathophysiology and medical management behind their diagnoses.
Mr. J was one such patient. A gregarious man with diabetes and Charcot arthropathy of his right foot, he had been sent to the ED after his wound care nurse discovered a foul-smelling discharge from the foot. Although Mr. J’s podiatrist had instructed him to remain non-weight bearing, he had continued walking at home in a CAM boot. It was easy, at first glance, to label this patient “non-adherent.” However, as I stopped by his room over several days, I learned that he lived with a roommate who was in her 80s, and he had been active on his feet to care for her. His “non-adherence” was not negligence, but an act of service. No EHR could have revealed such crucial information. Hearing his story required time and presence.
Mr. A was another patient whose story I got to know. He was a reserved gentleman in his late 70s who developed central cord syndrome after sustaining a fall at home. Following a laminectomy and prolonged hospitalization, Mr. A was discharged to an acute rehab facility, where he developed a bed sore that evolved into a gaping, 12-cm sacral decubitus ulcer. Despite initially presenting to an outside hospital, he was transferred to the VA to reconnect him with his outpatient infectious disease physician and coordinate his care. Mr. A was a quiet man whose stoic demeanor would soften at the mention of ginger ale. He would crack a half-smile and wink, asking for a sip. While my team waited for interventional radiology to perform a bone biopsy to guide his treatment, my role centered on ensuring his comfort by securing inflatable boots to offload the pressure from his heels and cracking open his windows each morning. In the two weeks that I cared for him, I learned that just three months prior, he had been entirely independent and had lived alone with his dog. His life had been radically altered within the span of a single season. He was now dependent for all his activities of daily living. The contrast between who he had been and who he was now was humbling. A traditional EHR, with its sparse summaries and fragmented notes, could never have captured the gravity of such a shift. It required conversations with Mr. A, his family, and my care team.
As my month at the VA drew to a close, what had once felt solely like a technological burden became an enabling constraint. I had initially dismissed CPRS as an outdated system adverse to the idea of innovation. However, rotating at the VA challenged me to reflect on nearly a year of clerkship rotations and reconsider what drew me to medicine in the first place. My training until then had largely occurred within a large, resource-heavy academic institution. The VA showed me how medical encounters in a different context carry a quiet dignity of their own. While sophisticated technology can streamline documentation, it can also smooth the contours of patients’ stories, containing them within templated summaries and shorthand. In an era when the field of medicine is filled with advancements, CPRS and the VA encouraged me to return to the fundamentals of medicine: listening, observing, and caring with patience.
Bonnie is a third-year medical student at the Perelman School of Medicine at the University of Pennsylvania. She enjoys painting outside the lines, cultivating her ever-growing plant collection, and tossing together hearty salads. She is a 2025–2026 Doximity Op-Med Fellow.
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Patient initials and identifying details have been changed.
