Medical students: Be sure to thank your patients

When listening with a stethoscope to a patient’s heart, one sometimes hears a deviation from the typical “lub-dub” rhythm. Sometimes the “dub” is too loud, or the “lub” too soft. There might be a rubbing sound, or a harsh blowing sound. By interpreting subtle characteristics such as the location, pitch, and timing of these sounds, one can sometimes diagnose things like a diseased heart valve or congestive heart failure. It’s very hard to do, and the surest ways to get good at diagnosing heart murmurs are to thoroughly understand the mechanisms of heart disease and to get lots of practice.

Our cardiology professors kindly arranged for me and my medical school classmates to examine patients with various audible heart abnormalities. We were divided into groups of eight and herded through a series of exam rooms. Three or four of us at a time would place our stethoscopes on each patient’s chest, and as a group we tried to diagnose the heart abnormality.

One patient had pulmonic valve stenosis, a rare murmur that most physicians will never encounter in their careers. Pulmonic valve stenosis is difficult to differentiate from its oft-encountered cousin, aortic valve stenosis, so finally hearing a patient with the rare pathology was quite useful. Some of the patients had severe disease, with classic physical findings that we’ve only read about in textbooks. One patient with severe aortic valve stenosis had pulsus tardus et parvus (“diminished and weak pulse”): the feeble pulse I felt in his wrist noticeably lagged behind his heartbeat. Examining these patients helped cement my clinical knowledge.

My understanding is that these patients, most of them elderly, had come in special, without compensation, to let us examine them. I can’t imagine that our examination was fun for them. The patients had to partially disrobe, and some of our stethoscopes probably were cold to the touch.

But patients seem happy to help us learn, whether it’s a couple who lets us examine their newborn or a psychiatric patient who lets us ask deeply personal questions about his life. When I tried drawing blood from one of my first patients, my first two “sticks” were unsuccessful and I informed her that I would get someone more experienced to perform the next attempt. She insisted that I keep trying until I succeeded, because she wanted to help me improve (I thanked her and found the more experienced student anyway).

Two volunteers had had their larynges (plural of “larynx”) removed because of cancer caused by smoking. They could breathe only through a hole that had been surgically carved in their necks (“stoma”), and could speak only with the help of assistive devices (which made them sound like Stephen Hawking). They spent an hour with us, taking our questions and letting us try out some of their assisted-speaking equipment. They also taught us some useful clinical pearls: since their mouths are disconnected from their lungs, if they need to be resuscitated, we need to ventilate their necks.

I make sure to thank these patients, and I hope they understand how much they are able to teach us. I’ve realized that some of the most eager volunteers are those who lead the humblest lives: although they are barely scraping by, they offer their assistance, expecting nothing in return. They have my gratitude.

“Reflex Hammer” is a medical student who blogs at The Reflex Hammer.

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  • Kobukvolbane

    What a nice article. The rest of us could also thank our patients for trusting us with their care.

  • ColdHands

    I’m always happy to help students out, as long as I’m asked first (that’s a whole other post). Thanks is always nice to hear, and so, thank you in return, for your consideration. :)

  • houriganterry

    I believe you understand aspects of mentoring that I at 64 am just awakening to.
    It can come “out of the blue”, and you can deliver it by surprise too.

    Since I got my own DX of colon ca, I have become different to the people I serve in ways that I could not have foreseen or comprehended: now, I can often perceive where they stand in the “maze”, and I get to stand with some of them, able to see things as they see, through a vision that wasn’t available
    to me two years ago. It is the best thing that could have affected my patients,
    and by extension, me.

    I guess a good analogy is the bond of experience between war veterans.
    Joe Biden told a family group, all of whom had suffered someone killed
    in the recent wars: “No one can understand what you are going through
    if they haven’t been there”. Having been there through the sudden death
    of his wife and son, he was able to say,
    “I can tell you for sure that the day will come
    when a smile comes to your lips
    before a tear starts to fall.”

    A man who was a critical mentor in my life told me in 1991:
    “Be open to receive. On a moments’ notice. From anywhere.
    Be committed to acknowledge, on a momemts’ notice, always.”

    I hope this makes some sense to you – chemobrain is real!

    Wonderful work. My day is already made.

    Terry

  • EmilyAnon

    I think you’ve got the right idea on how to get a patient to be on your side. An introduction, show appreciation, and a thanks at the end. With that, I’d be happy to be a part of your learning experience.

    Then once you become a doctor, the tables will turn and it will be the patient showing appreciation and thanking at the end.

  • http://twitter.com/FerkhamPasha Ferkham pasha

    Very good article

  • Doug Capra

    That’s the key — good communication and respect, on both sides. Most patients are quite willing to let medical students work with them in most (not all) situations — if they’re asked.

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