Sohit Bethireddy

It was during fall 2016 when I had a series of visits to a hospital as part of my medical school curriculum, where I began to feel more comfortable with patient interactions over time. My group arrived at the hospital and greeted the reception staff and the nurses and were able to establish a professional rapport. This facilitated them helping us find our preceptor and the ward efficiently. We were assigned to general medicine rotation in the female ward. We greeted our preceptor in the corridor, introduced ourselves, and he briefed us on our patient's background, something our prior preceptors had note done for us. The history was helpful as it gave us insight about the patient's hardships with her current illness.

He escorted us to the designated patient, greeted her, and asked how she was doing, also taking a moment to describe the beauty of the warm sunshine and sparkling seawater of the island. Then, he asked her for permission to be interviewed by our group. The initial rapport developed with the patient made her feel comfortable, jovial, and helped suppress her psychological distress from illness, making her inclined to meet with us. I introduced myself and the group to her and started with an open-ended question.

Normally, during our hospital visits, we do not get all the information we need from a patient with a single open-ended question. We have to interview them in many different ways to elicit maximal clinical information from them. In contrast, standardized patients in medical school tend to give the clinical picture with one or two open-ended questions. Due to the initial establishment of the friendly bond, our patient was very descriptive in her explanation and assisted us in obtaining the clinical picture easily. Strikingly, this was the first time during our hospital visits where the patient was able to give a vivid clinical picture of her condition with a single open-ended question, further highlighting the importance of patient rapport.

However, there were times when she felt so comfortable, she provided too much nonessential detail. I was reluctant to interrupt the her as I was afraid that I might offend her or cause her to not give us as much clinical information as we needed. At times, our preceptor intervened due to our time constraints. Similarly, we as students needed to learn professional techniques to conduct complete interviews in timed settings. Moreover, the patient's overly detailed account distorted the clinical picture, giving us a lot of information to analyze prior to arriving at our differential diagnosis.

Our patient was diagnosed with Type 2 diabetes at middle age. Unfortunately, she was one among many who had suffered an amputation due to a diabetes complications. When she described the gangrene that occurred on her limb due to poor healing of a bruise, I felt genuine empathy for her. This was a contrast to my reactions to standardized patients my classmates and I met with during small group encounters at medical school. Though they often describe previous surgeries, loss of their jobs, or other personal experiences, they don't elicit the same level of empathy our ‘real' patient did; something that would make me think of her days or months later.

The experience gained during that encounter made me stronger emotionally and highlighted the importance of patient interaction in obtaining patients' histories. Moreover, it enlightened me about the need for humanity and empathy in this noble profession. As aspiring physicians, we need to treat our patients as human beings, not as specimens with disorders.