Dr. M introduced us to our patient X, a man in his late twenties, complaining of unbearable abdominal pain, which prompted him to come immediately to the emergency room. He entered the room and sat silently, with a look of fear on his face of what was next to come. During the history, we really got to know X well. He was an honest man, candid with his alcohol and smoking habits and how he believes they are the culprits of his symptoms. I asked him if he gets regular check-ups from the doctor, and he explained that going to the doctor scared him. We finished the interview, and X was eager to know what was wrong with him. He wanted our opinions, from the "rookies;" as he would call us. I was on a hospital visit as part of my clinical skills course in my medical school curriculum with my classmates, or my teammates, as we would call each other. My team and I explained to him that he could be suffering from acute gastritis. We educated him on the cause of this possible condition, letting him know that alcohol and smoking, as he believes, may be the aggregating factors. After hearing this, he ‘fist-bumped' us and said, "I think you're right. You guys look smart and I trust you."
From looking fearful, to showing camaraderie, I wondered what made this visit so pleasant for X. I was proud of the team for being able to make this patient feel so comfortable in a setting that he was fearful of before. X hinted at what may have made him feel uncomfortable in prior doctor visits. He heard many stories of doctors prescribing medications without properly explaining their reasoning for them. X appreciated that we were explaining to him what proton pump inhibitors were, rather than blindly telling him to ‘take these medications.'
Keeping the patient informed throughout the whole patient care process builds trust and cooperation. This is similar to the style of interviewing we have ingrained within us during clinical skills courses, when we prompt patients to ‘teach back' during the closing phase of our interviews. I did not appreciate this as much before as I do now. The teach back not only builds our own confidence in knowing that the patient understands the plan of action, but it allows the patient to feel as though they are being cared for. They feel that the doctor is making an effort to ensure that they understand the plan of care, not just handing out therapy and diagnostic tests.
In my prior experiences in the clinical setting, I have often seen complacency in educating patients on modifying lifestyle and diet. However, Dr. M. was adamant in informing X that if he continued his alcohol and smoking habits, he would exacerbate his gastritis to an even more painful peptic ulcer. When X heard the consequences of continuing poor choices, he continued to say out loud, with a look of fear on his face, "I'm going to quit. I'm going to stop."
Although these are just words, it was still comforting to know that X was considering changing his habits. I learned a lot from watching Dr. M educate X. She was candid, honest, and blunt, yet she kept it lighthearted so he did not feel like he was in a malignant environment. My only wish was that I'd had more time to talk to X. I felt as though just knowing that he had alcohol and smoking habits was not enough. I wanted to understand why he has chosen this type of lifestyle, a lifestyle that could hurt him so much down the road. I felt as though delving into the psycho-social aspect would have helped in truly humanizing the alcoholism he was suffering from at such a young age. Perhaps understanding why and tackling those separate demons would help in the compliance and cessation of such habits that were detrimental to his health.
During this same trip to the hospital, Dr. M. showed us x-rays of patients she had in the past. She showed us the x-ray of a patient with breast cancer that metastasized to the lungs. Dr. M told us that the one thing the patient wished for was to be able to see her daughter walk at graduation. As I heard this story, I wondered, "How often have I asked a patient what his or her hopes were?" I often assume a patient merely wants to feel well enough to go home. But, as Dr. M explained this patient's story, it made me realize there is more to a patient's wishes than just hoping to "just feel better." This patient wanted to feel well enough so she could go to her daughter's graduation. This goal humanized the patient experience even more.
I hope that in my future patient interactions, I am able to build such an open rapport with my patients, making sure to ask them what they hope to get out of their visit to the hospital/clinic, what their long-term hopes and dreams are, and how I, as their doctor, can help them in achieving those goals.