This is likely a situation many students in the the healthcare field have encountered before. You walk in to the room to introduce yourself to a patient and you notice the patient getting increasingly agitated as you go through your H&P.
In the patient’s mind, YOU (the student), are the reason they haven’t been seen by the doctor yet. The perception oftentimes is that the doctor is right outside waiting to come into the room and the time you are spending with them is only postponing this encounter from occurring.
I can’t really fault the patient for being frustrated.
Health issues are stressful. Visiting a doctor’s office is stressful. Taking time off work to come to an appointment is stressful. Waiting 45 minutes after your scheduled appointment time only to be seen my a medical student can very easily be the tipping point for a person’s patience.
The reality of the situation is that clinical encounters can easily spill over the specific amount of time allotted for a patient. It’s not always possible to see a patient and address all of their concerns during a 15 minute visit.
A common practice in teaching clinics is that students are sent in to see patients while the physician catches up on encounters/orders/documentation. If you’re seeing 15 patients back to back, it really can become easy to get details confused so completing documentation as you go along is quite important for maintaining the integrity of healthcare.
The student goes in and tries to get a feel for the visit and tease apart things that need to be addressed by the physician during the encounter. If the student does their job well, the patient hardly ever needs to repeat their story to the doctor. Rather they get more time to elaborate on their concerns. It is both a learning opportunity for students and helpful to the physicians.
I’ve had a few encounters during third year where the patient told me at the beginning of our encounter that they would prefer to see the physician instead of speaking with me. The first time it happened, it really did hurt my feelings but I learned as time went on that it is important to not take these things personally and to stay courteous and professional.
A recent experience, however, left me quite baffled, confused and hurt. A patient I had gone in to see was really nice and open to talking with me. I performed what I thought was a thorough H&P and then asked permission to perform a physical exam. The patient allowed me to listen to his heart and lungs after which things started to shift.
As I asked to check his ankles for edema, he became suddenly exasperated and expressed frustration about having had to wait so long after his appointment time to be seen. I apologized for the wait he had to experience to which he replied “The reason it’s taking so long is because you’re in here asking me all these questions. Can you please wrap this up so the doctor can get in here?”
I’m not really sure what led to the sudden turn of events. The encounter had been going well from what I could glean and my mind still feels at unease today because I’m not sure if I did or said something wrong. I apologized again for his inconvenience and walked towards the door, promising to relay the information from our visit to the doctor. As I was leaving, he muttered an apology. I reassured him that it was no trouble and exited the room.
After speaking with the doctor she told me I could opt out of returning to shadow her encounter with the patient. There was a part of me that felt hurt and embarrassed that wanted to shy away from facing the patient that had displayed such overt frustration with me.
That’s not what medicine is though.
I opted to go back in and paid attention to the details of his management instead of letting my mind linger on emotions. It’s so tough sometimes to separate emotions from duty but with each such encounter I think I develop thicker skin. But I know I still have a long way to go.
(The picture in this post was taken in Washington, D.C. in a little garden close to the Smithsonian Air and Space museum)