Saman Karimi - Once Upon a Bedside

Having started my fifth term of medical school, I was very excited to have the opportunity to interact with hospital patients who truly needed our help and to have transitioned away from the standardized patients I had seen previously as part of my medical education. My wide-eyed enthusiasm was quickly accompanied by a sense of anxious excitement as I met my first hospital patient, a 46-year-old female presenting with recurrent deep vein thrombosis (DVT). This was not an actor volunteering as a standardized patient with purple marker lines mimicking a bruise, or a waxy paste resembling skin desquamations on the arm. This was a real patient with a very swollen left calf who was in excruciating pain and had a worried look on her face, which she struggled to mask with a nervous smile.

The patient's apparent distress instilled in me a sense of obligation to make her feel comfortable and put her at ease while taking her medical history. I was overwhelmed by her sheer confidence in our ability and felt an incredible sense of responsibility as she trusted us with some of the most intimate details of her life. I felt relieved and blessed that all of my pre-clinical training resulted in a patient interaction and medical interview that was worthy of this patient's trust.

As we proceeded with the preceptor-guided physical examination, it became apparent that she did not feel comfortable opening her mouth and later explained that she lacked confidence in her smile and often found herself embarrassed by her oral hygiene. This revelation put into perspective something that we as aspiring doctors often forget: our patients are complex human beings, each with distinct insecurities who often fear being judged. It is our responsibility to notice the uneasiness that results from this insecurity and to put their minds at ease by assuring them that the bedside is a judgment-free zone. This interaction provided us with a unique opportunity to practice good bedside manner, as we jokingly assured her that we were not dentists and that she had no reason to be embarrassed. We only sought to look at her mouth as part of a routine examination. I am still in awe by how quickly her facial expression changed and how quickly she was put at ease by this assurance, and the impact it had on our ability to quickly proceed with the physical examination.

It has always been my opinion that practicing good bedside manner is one of the most challenging and important responsibilities bestowed upon a physician. By addressing the difficulties, insecurities, and needs of our patients, we provide them the opportunity to put an incredible amount of trust and confidence in us as clinicians. This ultimately leads to an improved emotional state and enhanced patient compliance.

This patient interaction highlighted to me the importance of quickly identifying and addressing patient distress and insecurities, preferably before beginning the physical exam, in order to improve patient treatment outcome and the patient's confidence in me as a clinician. I am grateful to have had this experience, as it allowed me to test and apply patient communication skills I learned in a pre-clinical setting in a real-world environment where they're needed the most.