Many people think medical school is all about memorization and books. But some of the most valuable lessons I learned in my first year as a medical student came from a much different experience.
No matter what stage you are at in your journey, there are always new facts, techniques, and procedures to learn. You are presented with an enormous amount of information during your preclinical years. There is so much content, it is easy to forget that your job as a medical student is not to get lost in lectures, books, and videos.
Sometimes the most important learning does not take the form of facts about clinical symptoms or disease states but in one-on-one interactions with patients. A crucial exam I took last year taught me some valuable lessons about how to approach taking a patient’s history and performing a physical exam.
A face-to-face challenge
It took place during a standardized patient exam. Actors are hired to play the roles of patients; they interact with you and then evaluate your performance as a student doctor. We saw two patients during our end-of-year evaluation. We introduced ourselves, took histories, performed physical examinations and then discussed next steps with the patients. I received decent marks from one patient; the other gave me a poor score.
I like to think of myself as a social person who is fairly good at communicating and connecting with people. I had even practiced taking patients’ histories and performing physicals with real patients during my Introduction to Clinical Medicine rotations. Therefore, I did not fret much about the results of my standardized-patient evaluation.
To be honest, I’d left the room feeling pretty good about what I’d done. So when I received an email stating I had nearly failed the encounter, I was in disbelief. I thought I had asked all the right questions and had not skipped any part of the physical exam. Watching a replay of the encounter showed that this was mostly true — although I did forget to pull out the footrest.
Correcting and connecting
It took me a while to get over the initial shock of a poor score; it’s not something I am used to seeing. However, after reviewing the case with my preceptor, I realized that there are many lessons that will help improve my skills when interacting with patients.
At the beginning of the encounter, the patient seemed very reserved, and she was short with her responses. I assumed that this might have reflected her personality, and tried to continue with the appropriate steps of taking her history and performing the physical exam. Later we got to the root cause of her uneasiness. It turned out she was afraid of getting fired from her job, since she missed work a lot due to illness. After the patient was able to open up about this, her body language relaxed, and she was much more talkative throughout the rest of the interview.
I missed all of this until I watched the recording with my preceptor. He explained that if a patient looks worried, it is OK to acknowledge that concern and address it. As physicians, we are not supposed to be robots. I was so concerned with getting the order of the history-taking right that I did not put enough focus on connecting with the patient and understanding the origins of her worry.
Through this experience I gained important insights about patient care:
Never assume; always go into your patient interviews with an open mind. If I had done this, I might have identified the underlying cause of my patient’s unease sooner and changed the entire encounter, resulting in the patient feeling that I’d been properly attentive.
Listening is more important than talking. Listening is a skill that is underestimated in health care. I was definitely rambling. We are taught to ask open-ended questions and to let the patients share their stories.
Do not be afraid to show your own personality. The last piece of advice my preceptor gave is that he wished he “saw more of me” in the interview. At first, I was confused. “What do you mean? I’m right there!” I said. My preceptor explained, “Yes, but I know your personality; I have seen you interact in our groups and with other patients. In this encounter, it looked like you were matching the patient’s level of uneasiness. While emphasizing what you know is, of course, important, you want to show who you are and that you are comfortable. Patients will pick up on that, and they just may feel more comfortable too.” That advice really resonated with me. I realized that I was just not being myself enough in the interview.
Since that exam, I have brought these lessons into every patient encounter, and feel fortunate that we start honing these skills early on in our medical education.
Winston Churchill said it best: “Success consists of going from failure to failure without loss of enthusiasm.” So that is what I aim to do: learn from my mistakes, grow from them and remain positive throughout. I am confident that experiences like this will make me a better physician.
Adam Nessim is a medical student. This article originally appeared in the Doctor’s Tablet.
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