Medical school rotations afforded me incredible opportunities to bolster not only my knowledge base but also my patient-related skills. The following information has helped me provide better patient care; hopefully, it can be of some benefit to you as well.
1. Safety and no violence are not synonymous
During one of my outpatient rotations, I was interviewing a teenager who had come in for a routine annual checkup. Ten minutes into the appointment, a knock on the door signaled that it was time for me to leave to present the patient’s case to my resident.
At this point in the interview, we had addressed everything the patient wanted to discuss, so I wrapped up with a conversation about the psychosocial aspects of her life. As part of my routine mental health checklist, I made sure to ask her if she felt safe at her home, at school, and with the various people in her life, to which she responded that yes, she felt safe. For no particular reason, at this point I deviated from my usual social history script, and as a follow-up question I asked her, “OK, so you haven’t experienced or witnessed any violence or abuse?”
After this question, the patient paused for a few seconds and then quietly shared that growing up she had, in fact, witnessed a significant amount of inter-parental violence. As we talked more about her experiences, she divulged that actually, she wouldn’t mind meeting with a therapist to discuss this issue further. It was true that she currently felt safe, but the domestic violence that she had previously witnessed had been something she had never fully processed. Walking out of the room afterward, it occurred to me that if I hadn’t by chance followed up my usual safety question with the violence one, this is a topic that the patient likely would not have brought up at this visit. It would have been a lost opportunity to address an unresolved and clearly unsettling issue. Since this experience, I’ve made it a habit to always take the few extra seconds to ask about violence in addition to safety, in the hopes of preventing some potential mental health needs from inadvertently falling through the cracks.
2. The utility of a verbal, end-of-visit topic summary
As part of the standardized patient interviews that were a significant portion of my training, one communication technique was repeatedly emphasized was the importance of echoing in the questions you ask the patient. After all, it conveys that you have been actively listening to the patient share their story. An extension of this that I’ve found useful has been to close each patient encounter by verbalizing a brief summary of all that was discussed during the appointment. I’ve met many patients who are understandably frustrated about the short appointment slots that they’re offered with their providers.
However, even in the setting of such time constraints, I’ve witnessed providers expertly address numerous different issues with the patient. At the end of the appointment, in briefly bringing up a list of the different topics that were touched on, I’ve seen many a patient respond with a statement to the effect of, “Wow, we got through a lot, didn’t we?” I’ve found that a simple addition such as this has the potential to make for a more content and reassured patient.
3. Incorporate nursing interactions into your workflow
As a medical student, the sad truth of the matter is that you often don’t have a designated spot in the work room with the residents on your team, which means you’re left to find a workstation elsewhere. In these situations, I preferred working at the nearest nurse’s station, where I could complete my assigned tasks while still remaining in close proximity to different providers.
I remember being impressed by how expertly the nursing staff simultaneously juggled countless patient responsibilities while also having to deal with patients and visitors of varying temperaments. Seeing the many demands that existed on their time, I made it a priority early on to be especially mindful of not getting in their way. As a part of this, I always hesitated to interrupt their work to ask them questions about the patients we shared; after all, who was I as the medical student, still in training, to bother folks who were so busy?
However, as time went on, instead of just relying on indirect communication via the notes entered into the patient’s chart, I made it a habit to always try and check in with my patient’s nurse before heading in to talk to the patient. As one might expect, the extra insight from someone who had more face-to-face time with the patient routinely proved invaluable. I quickly found that this addition to my workflow had a profound impact on the care that our team was eventually able to provide the patient.
Moreover, when my resident or I would tell a patient, “We learned from talking to your nurse that …” time and time again, I saw that patients were visibly comforted upon realizing that there was behind-the-scenes communication that was expediting and furthering their care by allowing for integration across the different members of their health care team.
Subha Mohan is a medical student.
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