Throughout the first two years of medical school, we were taught the components of patient interactions through our LG meetings once a week. These components included the introduction/set up, HPI, types of history including past medical, and closing the encounter. Learning physical exams and how to prioritize possible diagnoses was key to the learning curve of LG. Throughout these meetings, my fellow peers proved to be my teachers early on while we would practice in front of each other. I learned the communication styles of 13 different people including Dr. Norton, our leader. However, as we neared the end of second year, our SPs proved to be the best teachers of them all. They taught me my own style and how to respond to different situations. Whether it was delivery bad news or performing physical exam maneuvers. We were repeatedly told that these components were going to come together eventually but being somewhat of a pessimist and impatient person, I did not believe it. That was until third year came along.
Third year brought more than just real patient encounters. We were no longer talking to “fake patients” whose jobs was to memorize fake patient information. We were talking to people who were afflicted by various health problems, most of the time, without many resources. My first real patient encounter was during my gynecology rotation at a clinic day. I talked to a patient who had been having urinary tract symptoms including painful urination and had a history of STIs. This patient had recently been treated for Chlamydia and wanted to be tested again. She mentioned that she believed her partner was cheating on her as he had cheated in the past. After finding out that she indeed did have an STD, my senior and I told our patient and she reacted very emotionally. She began to cry and wanted to leave as soon as possible. She said she was going to leave her partner but that would leave her homeless, again. I remember talking to fake patients about difficult diagnoses but this real patient interaction was not just about a difficult diagnosis. I did not lead this interaction since I was in my second rotation ever of third year and looked to my senior resident for advice. My senior resident had been having these interactions for the third time that day and knew exactly how to handle a distressed patient. We talked to social work and the patient was made aware of other resources. The patient still left the clinic crying and distressed but it was not going to be my last time in which a patient left this way. This patient taught me more than just how to treat chlamydia. She taught me how to have a conversation about homelessness and mental health. She taught me that patients are going to leave my appointments sometimes, hopefully not too many, unhappier than when they came in. Third year taught me, first how to talk to patients about more than just medicine. I learned how to gather medical histories in my own unique way. I learned how to do physical exams in ways that worked for the patients’ comfortability. I learned how to guide my interviews in a way that allowed me to generate a differential diagnosis. But most importantly and hardest of them all, I learned how to come up with a plan alongside my patient that worked for his or her unique situation.
Gynecology Rotation CPA
Sub-internship Rotation CPA
After finding my own way of talking and treating patients during third year, fourth year actually put me in the forefront of patient interactions. More specifically, during my sub-internship with the Oncology Team 1 at the James Cancer Hospital, I learned how to be part of the treating team of my patients. I took ownership of my patients and talked to their medical providers in other parts of the hospital. If it wasn’t for a curriculum that allowed me to come up with my own unique way of talking to my patients, I do not think I would have been comfortable enough to take the immense responsibility of my own patients early on fourth year. I know that my current way of prioritizing and communicating during patient interactions is still a work in progress. Residency is going to shape and change these practices and I am looking forward to seeing how this enriches my working life. My co-residents, medical students, nurses, PAs, and many others will become my new teachers in the upcoming years. However, I know that my own patients as an intern will change what I have become accustomed to but for the better. I plan on observing more experienced residents and choosing the skills that will best serve my patients. I also plan focusing on assessments by my fellow residents and medical students in order to fill in the gaps of my skills. I know that intern year and residency will improve my already vast skills but my patients will change how I see myself as a doctor.