Once in a while, I try to actually imagine myself as a doctor. It feels surreal, though, like I’m watching myself through several degrees of separation. Like Joey from Friends watching himself act as Dr. Drake Ramoray on TV. And what I see myself doing isn’t particularly impressive, either. It’s not like I’m holding a test tube and exclaiming I’ve found the cure for cancer (which I’ve heard is how that sort of thing happens) and I’m not figuring out a difficult diagnosis just by glancing at a patient’s labs. Instead, I’m simply walking into a patient’s room and greeting them.
“Hi ____! I haven’t seen you in a while. I suppose that’s a good thing, huh? So tell me, how are you? How are the kids?” Maybe I stride toward the bed and take the patient’s hand in both of mine. Maybe I’m greeting the patient’s spouse with the familiarity of an old friend. It’s always something like that. Always friendly, confident – almost intimate. This scene means so much to me because it means that the ideal me has established rapport with a patient through previous encounters. It’s the idea of being comfortable with myself and the patient, having the knowledge that I can and will do everything possible to help this patient. That’s such a basic concept, right? Yet it seems unattainable to me right now as I face my third year with both excitement and fear.
When I was shadowing as a first year, I remember the doctor making a joke to the patient. The patient laughed uproariously, and I chuckled in the corner. I don’t even remember what the joke was, but later, in the hallway, my mentor pulled me aside with a very serious expression. “You know, I only made that joke because I’ve known the patient for a long time. You shouldn’t joke around like that if you don’t know how the patient will react.” I nodded vigorously. I wouldn’t dream of it.
Later that day, while Dr. A was typing away at the computer, I noticed that one of her patients was wearing a University of Michigan fleece. “My parents went to U of M,” I ventured. “I grew up in Ann Arbor.”
“Oh really?” he smiled. A patient (one of many) expressing kindness toward a medical student. “Awesome. Go Blue!”
“Go Blue!” I agreed. And that was my first step into the world of Regular Conversation with Patients. Still, being comfortable with patients was a dream in the distance.
Fast forward to second year. It was the second half of the academic year, and I suppose we had learned enough “clinical skills” to be sent into patients’ rooms by ourselves. We were assigned to seek out one patient a week to talk to. It was my third or fourth time, so I had finally stopped saying my name like a question.
The patient I was talking to (whom I’ll call Mr. S) was a guy in his mid-50s, and we were getting along well. He had a minor head injury and was just killing time as they waited for his CT scan to come back. I finished obtaining the information for what later turned out to be a mediocre write-up. (I heard once that all medical students have a lot to write about a patient’s social history and very scarce information about anything else. It’s true!) Mr. S had pulled out his phone and was showing me photos of the motorcycles he collected with his brother. Then he showed me pictures of his brother’s kids. He also showed me photos of horses that he downloaded off of the Internet because he really liked horses.
“Hey, it’s been a few hours since I ate. Can you hand me my bag over there?” Mr. S pointed at a blue cooler on the chair. Once I brought it over, he unzipped it, rummaged through all the pill bottles he stored in there, and found a yogurt cup at the bottom. “Could you get me a spoon?”
I was happy to oblige. “But wait a second,” I teased. “Are you supposed to be eating or are you just trying to trick me?”
He laughed, but then his face fell. “I’m not sure.”
So I went to get a spoon and ask a resident for permission. It turns out that he was not allowed to eat until they got the results back. I ended up feeling guilty, like I’d robbed Mr. S of his chance to eat yogurt by making what I thought was a harmless joke. At the same time, it’s probably a good thing that I had asked first. It was a little thing, but I can just imagine that if a resident saw him eating yogurt after I left, they’d ask, “Who let you eat this?!” And I’d be in sunglasses with my collar up, shuffling out the door and never coming back.
What did I learn from all this? With each patient interaction, I catch a glimpse of how complex our relationship with patients can be. Maybe nothing I ever say to a patient can just be a lighthearted joke. Patient care is too serious for that kind of luxury. But I still believe that a physician can only provide thorough care by investing in conversations outside of the script. As medical students, we have the amazing opportunity to spend time on getting to know a patient so that they know we care about them as a team.
Well then, here’s to starting MS3. Hopefully I can keep the big picture in mind as I focus on sounding intelligent, not getting lost, and seeing things I may never get the chance to see again!
towardthatmd 