The vulnerability of a patient

People who work in healthcare are often dubbed as “the worst kind of patient.”

I used to think that it was an unfair generalization to say such a thing until I realized that I was quite literally a perfect example of that stereotype. A combination of shelf exams, board exams and clinical rotations had made it difficult for me to follow the instructions my physician had given me for follow-up of some lab abnormalities.

Now that I’m a fourth year and the dust has settled a bit (in a sense), I felt obligated to address the nagging feeling I had been experiencing for a while. Using the flexibility of my Emergency Medicine rotation schedule to my advantage, I returned to the doctor, did all the various labs and imaging and even kept up with my appointment to see the specialist this week.

This week was extremely eye-opening for me.

It’s not like I haven’t been to the doctor before. But my earlier experiences took place during my MS 2 year and very early on in my MS 3 year. Going to the doctor now after a full year of clinical experiences behind me, I can see how even the most minute details can either alleviate or exacerbate a patient’s stress.

For example, as a medical student when I have gone in to take a history with a time crunch, I’ve found myself getting a bit overwhelmed when people make small-talk for yes/no questions. I used to tell myself that when I went to the doctor I would answer only the questions I was asked, keep my problem list for each visit really short and not try to fill the blank time when the doctor is documenting with other questions that would potentially prolong the visit and put the doctor behind schedule.

But in my nervousness I kept making small talk when the nurse asked me questions and I felt like a total dummy when she gave me a subdued nod with a brief “uh huh”. I realized that I was being THAT patient that talks a little to much and tries to make jokes for everything.

In that moment, I felt extremely sad.

I was talking a lot because I was nervous. Each time she didn’t respond to a joke or a remark I made, I tried even harder to relate and made another joke/remark. Even a little response to one thing I was saying would have probably gotten me to shut up. But the experience left me with a slightly unpleasant feeling. The nurse wasn’t mean per se and she was definitely busy and did her job well, but a little bit of friendliness would have made a world of difference to me.

Today I saw my specialist and she has quite the impressive resume. I spent a lot of time going over how I was going to tell her what I had been experiencing. I had notes typed up on my phone to keep me on track so that I covered the important details in a timely manner. My appointment was scheduled for 30 minutes right before lunch and I didn’t want to ramble on and be the reason she had to skip lunch before seeing her afternoon patients.

The resident came to speak with me first and took a very good detailed history. A few minutes later the specialist I was there to see walked in and stayed for about two minutes max. She quickly told me the plan, shook my hand and walked out with the resident.

It was only due to my experience on rotations that I knew I needed to wait for the nurse to bring in my orders and my after-visit summary. It was only because I had some basic knowledge of medicine that I was able to ask her questions that got her to elaborate her clinical reasoning with me.

I can’t pinpoint exactly why, but I felt a little shortchanged by this visit. Is it wrong to have wanted the resident and attending in the room at the same time or possibly for the attending to take a little more time to talk to me? I had been putting off seeing a specialist for about 1.5 years. I got lost three times on my way to the hospital because I suck at driving around D.C. And I spent 30 minutes looking for parking in the overcrowded hospital parking garage. Sometimes I don’t think we realize the courage it takes for a patient to even show up to a doctor’s visit.

This week of clinic visits has taught me that I need to do a better job at making my patients feel comfortable. I need to learn how to stay efficient with my tasks while carrying on small-talk and not feel overwhelmed by it. If people come to one visit with multiple complaints, it’s not because they’re inconsiderate. Maybe they can only get a certain amount of time off work and they need to take care of everything at once. It’s not my place to make judgments. I need to work with what I have and come up with a reasonable plan. And lastly, as a physician, I want to be aware that a patient has taken time out of their day to come seek my counsel. Even if I can cinch their diagnosis in two minutes, I owe them time to make sure they understand what’s going on and that they feel comfortable with the plan.

-Bhuvani

{The photo for this post was taken as I nervously waited to meet my doctor in Sibley Memorial Hospital in Washington, D.C.}

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