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Can We Really Understand Our Patients?

The following post originally appeared on Medscape’s The Differential on January 12, 2011.

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Knowing I had recently completed a rotation in OB/GYN, a friend asked me how they (medical schools) make male medical students understand what their pregnant patients feel like. It was an interesting question. And it got me thinking about understanding what our patients go through – no matter their age, or sex, or condition.

As medical students, there is not much discussion about how our patients feel. Sure, there are classes about human suffering. But these classes deal with generalities. Each patient experiences their condition in their own unique way. To draw upon the obstetrical cases, telling a woman that she is pregnant can be met with a variety of responses that range from fear and dread to joy and elation.

I once heard Dr. Wil Alexander say, “The moment a symptom occurs, a story begins.” Those words seemed so profound at the time that I wrote the idea down and saved it. Each patient who walks through the hospital doors is more than a symptom. They are more than a diagnosis. They are more than a disease. They are human beings who have a story – a story that is just waiting to be told.

The question that my friend raised, regarding how male medical students are made to understand the experiences of their pregnant patients, made me realize that there is little done to help us understand our patients’ experiences. But I am okay with that. Because each experience is too individual to explain away with a blanket statement. It is impossible for anyone to know exactly how another feels.

The important thing, in my opinion, is for us to connect with our patients and convey that we acknowledge that they are going through a difficult or trying situation and to offer ourselves as they cope with it. It can be something as simple as giving them permission to be candid about their raw emotions – the frustrations and fears that build up – in a safe environment where no one will betray their trust or judge them or treat them any differently because of it.

It would probably be a good thing if we could understand exactly what our patients were experiencing. It would probably help many of us with our empathy. But without that ability to understand perfectly the experiences of our patients, we are left with the ability to accept perfectly the experiences of our patients. And I suspect that for most of them, this much is enough.

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Words With Patients

Let me set up the scene. I had just met my patient and examined her in her room. She was an older woman. She was an inpatient (meaning she was staying at the hospital). We were discussing a possible trip to the OR that day. I wasn’t sure if she would go that day or if the surgery would have to wait.

Nevertheless, our conversation was pleasant and I felt that we had fairly good rapport. We laughed and smiled throughout the conversation even though she was obviously anxious about surgery. And then this conversation happened:

Me: Well, it was good meeting you. I’ll probably see you later today. If you’re here tomorrow, then I’ll see you then too.
Her: If I’m here? Where would I go?

I sensed the panic in her voice. She sounded like I had just casually mentioned that her future existence was in question.

My only thought was that she could have gone home after surgery since I didn’t think the procedure was too serious. But poor, lady. She was thinking more negatively than I anticipated.

And once again, I was reminded how important communication really is. And seemingly innocent remarks can be understood in a completely different light that it was originally intended.

Oh, and I did clarify what I meant as soon as I heard her reaction. And we laughed again.