Jennifer Torres Yee
During one of my visits this term at Grenada General Hospital, I was assigned surgery with a cohort of my peers. Many of us were excited to see what case we would have for the day. After meeting with our supervising physician, we introduced ourselves to our patient and started our interview as planned. As VM, a 76-year-old woman, started to tell us what brought her into the hospital, I noticed a change of tone in the voice of the student who was directing the interview after finding out that our patient was not surgical. I felt the dynamic of the group go down in disappointment. Our patient had been admitted for severe chronic back and leg pain. Painkillers and anti-inflammatory medications had no effect in helping her. As the medical history continued, I learned that VM had a history of hypertension, obesity, and superficial thrombophlebitis. She had recently noticed some weight loss, which made her very happy! The interview ended in less than six minutes, but I still had many blanks in the patient's history that I wanted to fill.
"Superficial Thrombophlebitis" was one of the first medical phrasesI learned when I was in middle school. I did not know what it meant, but I linked it with ‘danger' because I always saw my family run around with my grandmother from doctor to doctor to get her better. Whenever I hear this term, it is like an alarm goes off in my mind and I instantly think of what my grandmother had to go through, and is still going through.
I remember sitting in a Bioethics & Behavioral Sciences lecture last year when I learned about paternalism and different projections we sometimes place onto our patients based on our own previous personal experiences. Was I projecting my grandmother's condition onto VM? Was I trying to push our group to dig deeper into the history and be more thorough in our physical examination? Maybe I started caring about VM as I would my grandmother.
Seeing how short the interview was, I took the initiative to ask more questions to VM. A couple of my classmates interrupted the interview at several points saying, "I don't think that's relevant at this point." I instantly replied, "I think it is. I want to clarify some things." I think that inquiring about the amount of physical activity in our patient was crucial, especially knowing that she had been dealing with chronic pain. Once I was done with my questions, I took a step back to let the next student conduct the physical exam. The majority group was focused on one system (nervous), while I still felt we had to integrate more systems: such as vascular and skeletomuscular. Some wanted to investigate lymphatics and skin. We were disorganized and ran out of time debating what we should do with the guidance of our supervising physician and were unable to discuss our differentials and reach a final diagnosis.
That day, while riding the bus back to school, not a single word was said between the members in my group. I felt we did not do our job as medical students. Rather, each of us was focused on doing and imposing what we each felt was best. We fell short of doing what was actually best for the patient. This was not teamwork. This day put into perspective the many challenges I will have to face in the near future as a 3rd year medical student, resident, and even as an attending. Accepting and recognizing my flaws early will help me provide the best patient care I can.