Some of my classmates take exquisite pleasure in their ability to diagnose an unusual disease etiology on their Tuesday clinical rounds. "I diagnosed Chlamydia psittici because I thought to ask about her pets." Others can't wait to brag about the unusual (and often disturbing) medical sights they saw. "We saw a guy with a necrotic...gangrenous...penis."
I'm a medical student. Of course this stuff interests me. Of course I would be excited if I was able to be the one who recognized the one clue that led you to an alternate (correct) diagnosis, of if I was able to see a really rare, gruesome, interesting disease process. I admit that. However, I think I'm different from many of my (more vocal) classmates. For me, the most interesting and rewarding parts of my Tuesday physical exam hospital rounds are my interactions with the patients.
One of medicine's really big pulls, for me, is the patient interaction. Science is great, but it's even better when it's science and a unique person with a unique personality and a unique history. It's not just the disease process, it's how the disease affects the individual's life. An ulcer is an ulcer, but how does the patient experience it? Deal with it? Require help for it? I've always known that patient interaction was a crucial part of the doctoring process, but I was never really sure how good I'd be at it. I don't want to make any premature judgments, and I certainly don't want to brag, but I think I've found out the answer:
I like my patients, and my patients trust me. This has been evident multiple times over the course of our physical exam course, when my patients tend to look to me for a smile or understanding even when my partner is doing the interview or exam, but it's been especially evident over the last two weeks. Two weeks ago, our patient was a young woman with cellulitis complicated by a deep vein thrombosis. She was in good spirits despite being in the hospital with an immovably swollen, painful, itchy leg. We performed a full physical exam, as always, to get practice at it. She asked a few questions along the way, curious about what we were doing. "We're listening for the size of your liver," I explained, or, "We're comparing the circulation in your legs." She reminded me of myself, simply curious and interested in the process.
Last week, our patient was a middle-aged woman with every chronic disease in the book -- what we like to call a "typical Bronx patient." Asthma, diabetes, emphysema, and some sort of upper respiratory infection that had landed her in the hospital for a few days, but she was friendly and cooperative. In taking a thorough history, my partner asked about her social history, which included drinking habits. "Ohhh...I drink a lot, we'll just say that." How much, my partner wanted to know. "We'll just leave it at that," she chuckled.
But this is a crucial part of the medical history, so I stepped in. I knew that patients often feel uncomfortable talking about how much they drink or smoke. I also knew that it can be hard to quantify sometimes, even if the patient isn't uncomfortable. I tried to help out. "How many days do you think you drink? Almost every day? A few days a week?" That was all it took.
She looked at me with a smile in her eyes. "Oh, pretty much most days, almost every day."
"What do you drink?" Sometimes it's easier to quantify when directly asked about the type of drinks.
"I love my Coors Light. I get me those big cans -- not the little ones, but the big 24-ounce ones." She gestured to show me the size of the can. "Yeah, the big ones. I like to have 'em nice and cold."
"How many do you usually drink?" I pressed.
"Oh, maybe 3. Sometimes 2, sometimes 4. Depends how I'm feelin'."
Usually when you ask about lifestyle habits, like smoking or drinking, you get a vague answer. Usually patients don't like to go into detail. They don't lie, but they don't really want to get into the whole story. I don't think it's because patients aren't trustworthy, or because they're unwilling to tell the truth. I think it's because we sometimes simply don't ask the right questions. All it took was a little understanding and creativity to get an answer that was much more full of details and trust than I needed or expected.
I like that. I like being able to connect with my patients, knowing that I'm able to excel at the part of medicine that pulled me into it in the first place. When we were done with the interview and exam, and we were about to leave the room, our patient asked us about our status in school. She was wondering how far along we were, and how much longer we had. I explained that we were in our second year, and that the first two years were mostly classroom learning whereas the third and fourth years will be spent in the hospital doing rotations, and that patients like her are our teachers. She loved that. She laughed and smiled, and thanked us. Thanked us? For poking and prodding her when she was already sick in the hospital? Yes, thanked us. Need more proof that we connected? She remembered my name. "Take it easy, Michelle!" I did. The rest of the day, I was elated.
I'm a medical student. Of course this stuff interests me. Of course I would be excited if I was able to be the one who recognized the one clue that led you to an alternate (correct) diagnosis, of if I was able to see a really rare, gruesome, interesting disease process. I admit that. However, I think I'm different from many of my (more vocal) classmates. For me, the most interesting and rewarding parts of my Tuesday physical exam hospital rounds are my interactions with the patients.
One of medicine's really big pulls, for me, is the patient interaction. Science is great, but it's even better when it's science and a unique person with a unique personality and a unique history. It's not just the disease process, it's how the disease affects the individual's life. An ulcer is an ulcer, but how does the patient experience it? Deal with it? Require help for it? I've always known that patient interaction was a crucial part of the doctoring process, but I was never really sure how good I'd be at it. I don't want to make any premature judgments, and I certainly don't want to brag, but I think I've found out the answer:
I like my patients, and my patients trust me. This has been evident multiple times over the course of our physical exam course, when my patients tend to look to me for a smile or understanding even when my partner is doing the interview or exam, but it's been especially evident over the last two weeks. Two weeks ago, our patient was a young woman with cellulitis complicated by a deep vein thrombosis. She was in good spirits despite being in the hospital with an immovably swollen, painful, itchy leg. We performed a full physical exam, as always, to get practice at it. She asked a few questions along the way, curious about what we were doing. "We're listening for the size of your liver," I explained, or, "We're comparing the circulation in your legs." She reminded me of myself, simply curious and interested in the process.
Last week, our patient was a middle-aged woman with every chronic disease in the book -- what we like to call a "typical Bronx patient." Asthma, diabetes, emphysema, and some sort of upper respiratory infection that had landed her in the hospital for a few days, but she was friendly and cooperative. In taking a thorough history, my partner asked about her social history, which included drinking habits. "Ohhh...I drink a lot, we'll just say that." How much, my partner wanted to know. "We'll just leave it at that," she chuckled.
But this is a crucial part of the medical history, so I stepped in. I knew that patients often feel uncomfortable talking about how much they drink or smoke. I also knew that it can be hard to quantify sometimes, even if the patient isn't uncomfortable. I tried to help out. "How many days do you think you drink? Almost every day? A few days a week?" That was all it took.
She looked at me with a smile in her eyes. "Oh, pretty much most days, almost every day."
"What do you drink?" Sometimes it's easier to quantify when directly asked about the type of drinks.
"I love my Coors Light. I get me those big cans -- not the little ones, but the big 24-ounce ones." She gestured to show me the size of the can. "Yeah, the big ones. I like to have 'em nice and cold."
"How many do you usually drink?" I pressed.
"Oh, maybe 3. Sometimes 2, sometimes 4. Depends how I'm feelin'."
Usually when you ask about lifestyle habits, like smoking or drinking, you get a vague answer. Usually patients don't like to go into detail. They don't lie, but they don't really want to get into the whole story. I don't think it's because patients aren't trustworthy, or because they're unwilling to tell the truth. I think it's because we sometimes simply don't ask the right questions. All it took was a little understanding and creativity to get an answer that was much more full of details and trust than I needed or expected.
I like that. I like being able to connect with my patients, knowing that I'm able to excel at the part of medicine that pulled me into it in the first place. When we were done with the interview and exam, and we were about to leave the room, our patient asked us about our status in school. She was wondering how far along we were, and how much longer we had. I explained that we were in our second year, and that the first two years were mostly classroom learning whereas the third and fourth years will be spent in the hospital doing rotations, and that patients like her are our teachers. She loved that. She laughed and smiled, and thanked us. Thanked us? For poking and prodding her when she was already sick in the hospital? Yes, thanked us. Need more proof that we connected? She remembered my name. "Take it easy, Michelle!" I did. The rest of the day, I was elated.
"How beautiful are all his works!
ReplyDeleteeven to the spark and fleeting vision!
The universe lives and abides forever;
to meet each need, each creature is preserved.
All of them differ, one from another,
yet none of them has he made in vain,
For each in turn, as it comes, is good;
can one ever see enough of their splendor?"
(Sirach 42)
Yeah, people are probably the most incredible creation ever. Amen.
LOVE rose