Always ask your patient this one thing


8:00 a.m.: Monday mornings are abhorred by almost everyone, but they are gloomier if you work as an intern. For me, this Monday was an anticipated work-free day — hence, it wasn’t too bad.

I had spent a long time at breakfast catching up with friends and later grabbed my books and went to the library to catch up on my studies. This happiness was short lived. And in the afternoon, I was called to assist the clinics and a day of no work turned into a workday again.

2:30 p.m.: I grabbed coffee, rushed to the clinics and began my job of taking a detailed history of the patient. The patient was a twenty-year-old girl who didn’t talk much and replied mostly in a yes or no. I started my usual work, asked her questions about her disease, did a thorough examination and the hardest part of listing possible differentials and chalking out a plan for treatment. I did my work, stepped out of the room and discussed the case with a senior to be sure of my diagnosis, and I began brainstorming about the possible things about which I could be questioned.

I was rotating in neurosurgery, so my knowledge of the various neuro diseases at this point was not apt. To keep up with the impression of being a good clinician, I resorted to Google and read up on a few syndromes to augment my knowledge. Just to be sure that when asked about the disease the patient has, I know exactly which gene is missing on which chromosome arm, what signs and symptoms it can present with and what possible treatments are available. I did my best and read up much as I could in 10 minutes.

3:00 p.m.: When my consultant arrived, I confidently presented my case, and everything went thing smoothly. The patient was a 20-year-old girl who was diagnosed with a brain tumor at the age of fifteen. Ever since then, she had undergone surgeries and therapies to recover. At this visit, she was doing well on the medications, and we decided not to alter treatment.

3:15 p.m.: To my surprise, the consultant agreed with my plan that I had worked so hard on … for the last 20 minutes. However, my consultant asked me, “ So, did you ask the patient what she does?” And here, my past few minutes of hard work melted away, and I couldn’t answer because I didn’t bother asking my patient. I was so busy thinking about what she has, how it was treated and all those textbook details that I need to know about her disease that not for a second I thought I should have chit-chatted a bit to know about how she is doing otherwise.

“Beta, this girl has been through so much at a young age, at least ask her if she studies or does something to keep herself busy,” said my consultant in a displeased manner. “Take some interest in the patient,” he added. And then we asked the patient about her personal life, and I was amazed to find out that she had resumed her education and was now in a diploma program.

4:00 p.m.: I realized that doctors are so absorbed in the disease that we treat the other person as an object and work on getting every single detail right. From diagnosis, examination, treatment, and prognosis, we neglect the fact that the person we are examining deserves a little extra attention and conversation. By saying so, I refer to the conversation where you ask about what they do, like their hobbies and education. Questions outside the sphere of clinical history — just the casual conversations we often have with strangers at any social meeting. That’s because, in the process of healing, medicines play a pivotal role but so does the mind and creativity.

The fact that people who are diagnosed with a critical disease at a young age find it hard to catch up with their peers and this results in depression. To stay in a healthy mental state is the crux to therapy no matter what the illness is. It is indeed vital to converse with the patient and find out about their personal lives.

It is after this incident that I make it a point to be sure I know what the patient does in their personal time to keep busy or what they aspire to do. Not only has this improved my patient-doctor relationship but also clinical skills.

Natasha Khalid is a physician in Pakistan.

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